Full-endoscopic discectomy through interlaminar approach for the treatment of L5/S1 non-contained lumbar disc herniation

English Keywords:Lumbar disc herniation  Percutaneous endoscopic discectomy  Interlaminar approach

English Abstract:

  【Abstract】 Objectives: To prospectively investigate the clinical outcome of full-endoscopic discectomy through interlaminar approach for L5/S1 non-contained lumbar disc herniations. Methods: From April 2011 to December 2011, 72 cases with L5/S1 imtracanalicular non-contained disc herniations were treated with full-endoscopic discectomy through interlaminar approach. There were 36 females and 36 males. The average age was 40.5 years(range, 18-78y). 51 cases presented with disc protrusion and 21 with sequesteration. L5/S1 disc herniation was divided into three types according to position of herniated disc related to ipsilateral S1 nerve root: axilla type(30 cases), ventral type(28 cases), shoulder type(14 cases). As for axilla type, the endoscope and working channel was placed between S1 nerve root and dural sac, while as for shoulder and ventral type, the endoscope and working channel was placed laterally to S1 nerve root. MRI was pereformed 1 day and 3 months after operation to evaluate the residue nuclear pulposus. Visual analogue scales(VAS) of low back pain and sciatica, Oswestry disability index(ODI) of preoperation, 3 months, 6 months and 12 months postoperative was recorded and compared. MacNab scores and functional status of S1 nerve root were evaluated at the 12-month follow-up. Results: All operations were completed successfully. The average operation time was 45min(20-80min). Reoccurrence was noted in only 1 case 2 months after primary operation and revisional microendoscopic discectomy was performed. The other 71 patients achieved good MRI outcomes 3 months after operation. No nerve injury and infection were noted. Postoperative ODI and VAS of low back pain and sciatica significantly decreased at each time point(P<0.05). MacNab scores of 12-month follow-up included 44 excellent, 26 good, 1 fair and 1 poor; functional status of S1 nerve root showed significant recovery. Conclusions: Based on the sites of prolapsed or sequestered disc materials, full-endoscopic L5/S1 discectomy through interlaminar approach is safe, rational and minimal invasive, its short-term clinical outcome is reliable.