Recherche clinique

Upper lumbar disc herniations (L1–L4) are less common and technically more challenging to treat because of the narrower spinal canal and proximity to critical neural structures. In our EndoLEVEL study, we analyzed 806 patients treated with full-endoscopic lumbar discectomy and showed that upper-level herniations achieved pain relief, functional recovery, and patient satisfaction comparable to lower lumbar levels. These findings confirm that endoscopic spine surgery is a safe and effective minimally invasive option for disc herniations at all lumbar levels.

This multicenter French study evaluated 144 patients operated on for lumbar disc herniation associated with moderate to severe motor weakness. At final follow-up, 58% of patients achieved complete motor recovery. The strongest predictor of full recovery was an improvement in muscle strength on the first postoperative day. Earlier surgery was the only modifiable factor associated with better neurological outcomes, highlighting the importance of rapid diagnosis and timely treatment for patients presenting with motor deficits.

Postoperative recovery after lumbar spine surgery varies widely from one surgeon to another, particularly regarding the use of braces, follow-up imaging, and timelines for returning to work and sports. In this nationwide survey conducted by the French Society of Spine Surgery, 239 French spine surgeons reported their usual postoperative recommendations. Most surgeons do not prescribe a brace after non-instrumented procedures, and routine imaging is generally avoided unless instrumentation has been used. Return to work is usually recommended after about 6 weeks for standard decompression surgery, while sports are generally postponed for at least 3 months.

EndoSaline is an international multicenter study comparing saline consumption during lumbar disc herniation surgery. Among 722 patients, endoscopic techniques used substantially more irrigation fluid than conventional microdiscectomy: approximately 4 liters for uniportal endoscopy and 9 liters for biportal endoscopy, compared with less than 100 milliliters for standard surgery. These findings highlight the need to better assess the environmental impact of modern surgical techniques and to promote more responsible use of healthcare resources.

Recurrent lumbar disc herniation is often considered more challenging to treat because of scar tissue from prior surgery. In this study of 843 patients, full-endoscopic lumbar discectomy provided clinical outcomes comparable to those of first-time surgery, with significant improvements in pain, function, and quality of life. Complication rates remained very low at around 2%, even in revision cases. These findings confirm that endoscopic surgery is a safe and effective option for treating recurrent disc herniations.

The results of this survey contribute to the existing literature and highlight the current trends of endoscopic spine surgery in France. Although the benefits of minimally invasive spine surgery are well documented and were confirmed by surgeons in this survey, lack of training and cost of equipment are major barriers that need to be controlled to expand the adoption of this technique.

FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods.

This case report outlines a review of the patient's clinical report, imaging, operative procedure, and complications, together with a literature review on pseudocysts after endoscopic lumbar discectomy.

Transforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.