[Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L₅S₁ lumbar disc herniation]

Abstract

Objective: To investigate the clinical effects of percuteneous endoscopic interlaminar discectomy(PEID)and fenestration discectomy(FD) for the treatment of L₅S₁ lumbar disc herniation(LDH).

Methods: A retrospective analysis was made on 86 patients with L₅S₁ LDH from January 2014 to March 2017 and followed up. According to the different surgical methods, the patients were divided into PEID group(43 cases) and FD group(43 cases). All operations were performed under general anesthesia. Forty-three patients in PEID group underwent percuteneous endoscopic interlaminar discectomy (PEID) and other 43 patients in FD group underwent classical fenestration discectomy (FD). Operative incision, operative time, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery, complication were compared between two groups. Pre- and postoperative visual analogue scale(VAS) of affected extremity pain and lumbar pain were recorded. Postoperative creatine kinase (CK) was observed in two groups. Modified Macnab criteria was used to evaluate the clinical effects. MRI was used to observe the survival rate of paraspinal muscle after operation.

Results: The length of skin incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery of PEID group and FD group were(0.7±0.1) cm, (8.0±3.0) ml, (3.0±1.5) d, (1.0±0.5) d and(5.0±1.8) cm, (62.0±50.5) ml, (11.0±2.5) d, (3.0±0.8) d, there was significant differences between two groups(P<0.05). VAS of affected extremity at 24 hours and 1 year after operation was obviously decreased in two groups(P<0.05), but there was no significant difference between groups(P>0.05). VAS of lumbar pain in PEID group and FD group were respectively (2.99±0.32), (5.44±1.31) scores at 24 hours after operation, and (1.56±0.60), ( 3.05±0.24) at 1 year after operation, there was significant differences between two groups(P<0.05). CK at 24, 48 hours after operation of FD group were obviously increased(P<0.05). According the modified Macnab criteria to evaluate the clinical effect, the rate of excellent and good of PEID group and FD group were 93% and 95%, respectively. The survival rate of paraspinal muscle by MRI in PEID group at 1 year after operation was higher than that in FD group(P<0.05). No complications such as spinal dura mater tearing, nerve root injury, vascular injury, intervertebral space infection were found in two groups.

Conclusions: Both of the two methods are safe and can obtain satisfactory effect, but PEID is more in line with concept of minimally invasive and has more advantages in paraspinal muscle protection, operative incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after operation.

Keywords: Discectomy; Fenestration discectomy; Intervertebral disk displacement; Percuteneous endoscopic interlaminar discectomy.