A mid-term comparison between percutaneous endoscopic interlaminar discectomy and micro-endoscopic discectomy for L5/S1 lumbar disc herniation

English Keywords:Lumar vertebrae  Intervertebral disc displacement  Surgical treatment  Endoscopy  Laminectomy

English Abstract:

  【Abstract】 Objectives: To compare mid-term clinical outcome between percutaneous endoscopic interlaminar discectomy(PEID) and micro-endoscopic discectomy(MED) for special type L5/S1 lumbar disc herniation. Methods: A total of 84 cases with special type L5/S1 lumbar disc herniation were included from February 2013 to February 2015. They were randomly divided into 2 groups, with 42 cases treated with PEID and 42 cases treated with MED. The data including the length of skin incision, the operation time, the exposure of intraoperative fluoroscopy, the postoperative hospital stay, the complication rate were recorded. The evaluation of clinical effectiveness was based on the Oswestry disability index(ODI), visual analogue scale (VAS), and modified MacNab criteria. Results: All the procedures were performed successfully. In PEID group: the operation time was 35-80min, averaging 54.4±10.6min; incision length was 7mm; hospitalization time was 2-5 days, averaging 3.4±0.6 days; C-arm time was 2-5 times, averaging 2.4±0.5 times. While in MED group: the operation time was 45-90min, averaging 65.4±12.4min; incision length was 18mm; the hospitalization time was 3-8 days, averaging 5.4±1.2 days; C-arm time was 2-5 times, averaging 2.3±0.6 times. The operation time, length of incision and the postoperative hospital stay in PEID group were less than those in MED group(P<0.05). There was no significant difference between the 2 groups on C-arm time(P>0.05). In PEID group, the preoperative low back pain and leg pain VAS score were 2.4±1.0 and 6.4±1.3 respectively; 1.4±1.2 and 1.0±0.8 at one day of postoperation; 1.6±1.4 and 1.2±0.6 at one month; 2.0±1.6 and 1.8±1.4 at 1 year; the preoperative and 1 year postoperative ODI were (58.4±18.0)% and (18.4±10.0)% respectively. In MED group, preoperative low back pain and leg pain VAS were 2.6±1.2 and 7.0±1.0 respectively; 2.2±1.0 and 1.8±1.6 at one day of postoperation; 2.0±1.3 and 1.6±1.1 at one month; 2.2±1.5 and 2.1±1.2 at 1 year; preoperative and one year postoperative ODI were (60.2±17.2)% and (20.0±14.2)% respectively. Postoperative VAS in both PEID group and MED group significantly improved compared with preoperative ones(P<0.05). In the first day after operation, VAS in PEID group was significantly lower than that in MED group(P<0.05). While between preoperation and one year after operation, there was no significant difference between PEID group and MED group with regard to VAS and ODI(P>0.05). One year after operation, according to the modified MacNab criteria, the excellent and good rate was 90.9% in PEID group and 92.7% in MED group, but there was no significant difference(P>0.05). Conclusions: It is certain that PEID and MED are effective minimally invasive surgical technique for special type L5/S1 lumbar disc herniation in Mid-term. PEID is superior than MED.