Introduction:

The possibility of developing failed back surgery syndrome, which may be related to the size of the access pathway to the pathology, is a major concern. When the herniation lies at the L4-L5 level (the most common level in our experience) the particular anatomical dimensions and confined space create a requirement for greater access trauma, when typical surgical approaches are used.

Methods: Utilizing a small working channel endoscope through a double postero-lateral approach provides a better alternative to open surgery, by addressing the problem with minimal surgical trauma. This method substantially reduces the likelihood of developing post-surgical long-term complications.

Results: 43 patients from 2002 and 2003 were retrospectively analyzed. 11.63% (n= 5) were females and 88.37% (n= 38) were males (average age 38.55 years) (19-60). The results were tabulated utilizing the MacNab criteria. 70% of the herniations were contained and 30% uncontained. No limitations to access were found on wide view CT scans. All patients had two small postero-lateral approaches made to the L4/L5 disc pathology.

EXCELLENT: 25.58% (n=11), GOOD: 67.44% (n=29), FAIR: 4.65% (n=2) and POOR: 2.32% (n= 1). Overall SUCCESS RATE was 93.02%. No complications. Follow-up averaged 3 months.

The success rate in uncontained herniations was better than in contained herniations: 100% vs. 90% respectively.

Conclusions: In L4-L5 lateral recess herniations, the traditional surgical approach increases the probability of the development of surgical failed back syndrome. Whereas, in this group, the small outpatient double-access endoscopic approach is highly successful, extremely safe and more surgically conservative.