[Treatment of L₄,₅ lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches]

Abstract

Objective: To analyze the clinical efficacy, indications and operative points of transforaminal approach and interlaminar approach in the treatment of L₄,₅ lumbar disc herniation.

Methods: A retrospective analysis was performed on 48 patients with L₄,₅ lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy from November 2016 to June 2018. Among them, 32 patients underwent percutaneous endoscopic transforaminal discectomy(PETD), including 17 males and 15 females, with an average age of (60.22±16.55) years, and the course of disease was(2.18±2.68) months;16 patients underwent percutaneous endoscopic interlaminar discectomy(PEID), including 7 males and 9 females, with an average age of (42.25±15.89) years, and the course of disease was(2.90±3.02) months. VAS, ODI of two groups before operation, 3 days, 3 months, and 6 months after operation were analyzed, and modified Macnab standard was used to evaluate the clinical effects.

Results: All the 48 patients successfully completed the surgical treatment, and all patients were followed up. There was no significant difference in gender, course of disease and follow-up time between two groups (P>0.05). The age of PETD group was(60.22±16.55) years and PEID group was (42.25±15.89) years, there was statistical difference between two groups (P<0.05 ). In the PETD group, there were 10 patients with advanced age, non-free type(24 cases) was more than free type(8 cases), and shoulder type(27 cases) more than axillary type(1 case) and ventral type(4 cases). PETD was used in 5 patients with lateral type and 2 patients with extreme lateral type. In PEID group, the axillary type(8 cases) was more than the shoulder type(2 cases) and the ventral type(6 cases), PEID was used in 4 patients with high prolapse free type(I and IIregions). VAS scores and ODI of patients in two groups at each postoperative follow-up point were significantly improved compared with those before surgery(P<0.05). According to modified Macnab standard to evaluate the clinical effect, in PETD group, 24 cases obtained excellent results, 5 good, 2 fair, 1 poor, while in PEID group, 12 excellent, 3 good, 0 fair, 1 poor.

Conclusions: Both two surgical approachs can achieve satisfactory efficacy in treating L₄,₅ lumbar disc herniation, but PETD is more suitable for elderly patients, non-free type, lateral type, extremely lateral type and shoulder type of lumbar disc herniation. High prolapse(I and II regions) and axillary type lumbar prominent should select PEID.

Keywords: Endoscopes; Interlaminar approach; Surgical procedures, minimally invasive; Transforaminal approach.