Percutaneous endoscopic lumbar discectomy by interlaminar approach or transforaminal approach for L5/S1 disc herniation: a control study of short-term results

English Keywords:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Transforaminal  Interlaminar  Minimally invasive

English Abstract:

  【Abstract】 Objectives: To compare the short-term results of percutaneous lumbar discectomy for L5/S1 disc herniation via interlaminar approach and transforaminal approach. Methods: From January 2010 to June 2010, a total of 60 patients were divided to percutaneous endoscopic interlaminar discectomy(PEID) group and percutaneous endoscopic transforaminal discectomy(PETD) group, there were 30 patients in each group undergoing percutaneous endoscopic lumbar discectomy by either interlaminar approach or transforaminal approach. The sex, age, herniation type, operation time, intraoperative fluoroscopy times, postoperative bed rest time, length of hospital stay, complications and surgical results between 2 groups were compared. Both groups were followed up by using the following measurements: Oswestry disability index(ODI), VAS and modified Macnab classification. Results: There was no significant difference in sex, age or herniation type between two groups(P>0.05). In PEID group, the operation time was 65.0±14.9mins, intraoperative fluoroscopy times were 3.0±1.1, postoperative bed rest time was 6.5±1.1 hours, hospital stay was 4.8±1.1 days; while in PETD group, the operation time was 86.0±15.4mins, intraoperative fluoroscopy times were 37.5±7.5, postoperative bed rest time was 5.0±1.1 hours, the mean hospital stay was 4.6±1.2 days. PEID group had less operation time and intraoperative fluoroscopy times than PETD group(P<0.01). There was no difference in postoperative bed rest time or length of hospital stay between 2 groups(P>0.05）. In PEID group, 2 patients were complicated with postoperative dysesthesia and 1 patient had recurrent disc herniation, while in PETD group 1 patient occurred postoperative dysesthesia and 0 patient had recurrent disc herniation. There was no difference in complication rates or recurrent rates between 2 groups(P>0.05). The average follow-up time of PEID group and PETD group was 27.2±3.7 months and 28.2±3.9 months respectively, which showed no difference between two groups(P>0.05). In PEID group, preoperative VAS was 7.90±1.42, ODI was (59.0±16.0)%; and the last follow-up VAS was 2.20±1.37, ODI was (20.4±7.7)%. In PETD group, preoperative VAS was 7.60±1.40, ODI was (60.1±13.7)%; last follow-up VAS was 2.30±1.02, ODI was (22.0±9.1)%. Both groups had a significant change in ODI and VAS score(P<0.01). There was no difference in preoperative or last follow-up VAS, ODI scores between two groups(P>0.05). The satisfaction rate of modified Macnab classification in PEID group was 93.3%: there were 22 excellent, 6 good, 2 fair; and the satisfaction rate in PETD group was 90.0%: there were 20 excellent, 7 good, 3 fair. There was no difference between two groups(P>0.05). Conclusions： The short-term clinical results of the PEID are equal to the PETD for the L5/S1 LDH. Compared with the transforaminal approach, the interlaminar approach is superior in less operation time and less radiation exposure.