Percutaneous Endoscopic Transforaminal Decompression in the Treatment of Patients with Migrated Lumbar Disc Herniation: A Retrospective Study

Yu Yao; Rongqing Qin; Qijie Feng; Xingjie Jiang; Pin Zhou; Ziyi Guo; Feng Zhang

doi:10.1016/j.wneu.2019.04.195

Percutaneous Endoscopic Transforaminal Decompression in the Treatment of Patients with Migrated Lumbar Disc Herniation: A Retrospective Study

World Neurosurg. 2019 Aug:128:e562-e569. doi: 10.1016/j.wneu.2019.04.195. Epub 2019 Apr 29.

Authors

Yu Yao¹, Rongqing Qin², Qijie Feng³, Xingjie Jiang¹, Pin Zhou⁴, Ziyi Guo⁵, Feng Zhang⁶

Affiliations

¹ Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China; Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Nantong, China.
² Department of Orthopedics, Gaoyou People's Hospital Affiliated to Soochow University, Yangzhou, China; Medical College of Nantong University, Nantong, China.
³ Medical College of Nantong University, Nantong, China.
⁴ Department of Orthopedics, Gaoyou People's Hospital Affiliated to Soochow University, Yangzhou, China.
⁵ Department of Orthopedic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China; Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
⁶ Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China; Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Nantong, China. Electronic address: zhangfengdoctor@sina.com.

PMID: 31048055
DOI: 10.1016/j.wneu.2019.04.195

Abstract

Objective: We aimed to discuss the surgical strategies, safety and clinical efficacy of percutaneous endoscopic transforaminal decompression for the treatment of patients with migrated lumbar disc herniation.

Methods: This is a retrospective study. From May 2014 to April 2017, a total of 56 patients (32 men and 24 women) with migrated lumbar disc herniation were operated on by percutaneous endoscopic decompression via transforaminal approach. All enrolled patients had clinical symptoms with radiculopathy, and were identified as single-level, soft herniated disc by computed tomography and magnetic resonance imaging. Clinical efficacy were evaluated chiefly by leg pain visual analogue scale score, Oswestry disability index score, and modified MacNab criteria.

Results: Patients were all successfully treated by percutaneous endoscopic transforaminal decompression, with an mean operation time of 63 ± 12 minutes. The patients were followed up for a mean duration of 15 ± 2.7 months (range 12-18 months). The leg pain visual analogue scale score was dropped from 8.2 ± 1.9 preoperatively to 2.4 ± 1.5, 2.2 ± 1.3, and 1.8 ± 1.1 at 1, 6, and 12 months after the operation, respectively. Similarly, the Oswestry disability index score was also decreased from 62.4 ± 8.2 preoperatively to 18.4 ± 6.2, 12.6 ± 5.1, and 9.2 ± 3.4 at 1, 6, and 12 months postoperatively. There were 38 excellent cases, 13 good cases, and 5 fair cases by the assessment method of modified MacNab criteria at 12 months after the operation, with an excellent and good rate of 91.07%. Two cases were complicated with low extremity numbness, which were recovered by conservative treatment in 3 weeks. No persistent neurological deficit or infection occurred in this group postoperatively.

Conclusions: We consider that percutaneous endoscopic decompression via transforaminal approach provided a safe, effective and minimally invasive alternative for the treatment of patients with migrated lumbar disc herniation.

Keywords: Lumbar disc herniation; Migrated; Minimally invasive; Percutaneous endoscopic transforaminal decompression.

MeSH terms

Adult
Aged
Aged, 80 and over
Decompression, Surgical / methods*
Diskectomy, Percutaneous / methods*
Female
Humans
Intervertebral Disc Displacement / complications
Intervertebral Disc Displacement / surgery*
Lumbar Vertebrae / surgery*
Male
Middle Aged
Neuroendoscopy / methods
Radiculopathy / etiology
Radiculopathy / surgery*
Retrospective Studies
Treatment Outcome