Application of interlaminoplasty technique during the percutaneous endoscopic interlaminar discectomy for L4/5 disc herniation

English Keywords:Full-endoscopic interlaminar approach  Interlaminoplasty  L4/5 disc herniation

English Abstract:

  【Abstract】 Objectives: To evaluate the application value and clinical outcome of full-endoscopic interlaminar approach by interlaminoplasty technique for L4/5 disc herniation. Methods: From February 2013 to August 2013, 90 cases including 60 males and 30 females undergoing full-endoscopic interlaminar approach due to lumbar disc herniation in our institution were reviewed retrospectively. The age ranged from 22-68 years, with a mean of 41.4±13.3 years. 38 patients with L4/5 disc herniation were assigned in group A, and 52 patients with L5/S1 disc herniation were assigned in group B. Radiological assessments were performed and analyzed pre- and postoperatively. Clinical data including the operation time, hospitalization, time to return to work and complications were compared between the two groups. Clinical outcomes were assessed according to the visual analogue scale(VAS), Oswestry disability index(ODI) and modified MacNab criteria. Results: Follow-ups of more than 2 years were completed in all patients, the mean follow-up was 34.8±4.0 months(25-42 months). Interlaminoplasty technique was performed for access-related osseous resection at L4/5 level. A significant difference between the groups was disc type. The mean operation time in group A and B was 73.1±9.7min and 55.2±7.5min, respectively. There was a significant difference in the operation time between the two groups(P<0.05), but not in the hospitalization, time to return to work or complication rate(P>0.05). The postoperative VAS scores for back and leg pain, as well as the ODI, obviously improved in both groups when compared with preoperation(P<0.05). According to the MacNab criteria, the satisfactory rates were 84.2% and 86.5% in group A and B, respectively(P>0.05). Conclusions: Although the operation time is prolonged in L4/5 discectomy by using interlaminoplasty technique, full-endoscopic interlaminar approach can be a safe and effective technique for L4/5 disc herniation and provide an equally satisfactory clinical outcome with L5/S1 discectomy, and there is no raising of the potential risks in nerve injury and lumbar instability.