Clinical comparative study of holmium laser in percutaneous endoscopic lumbar discectomy

English Keywords:Percutaneous endoscopic lumbar discectomy  Holmium laser  Lumbar disc herniation  Back pain  Recurrence

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and efficacy of holmium laser in percutaneous endoscopic lumbar discectomy(PELD) for lumbar disc herniation(LDH). Methods: From January 2016 to July 2013, 138 cases with LDH undergoing percutaneous endoscopic lumbar discectomy via an interlaminar or transforaminal approach in our institution were divided randomly into group A and group B. Patients in group A underwent the PELD combined application of holmium laser, while patients in group B underwent the regular PELD. Clinical data including the operation time, hospitalization, complications and recurrence were recorded. Clinical outcomes were assessed according to the visual analogue scale(VAS), Oswestry disability index(ODI) and modified MacNab criteria. Results: A total of 138 cases completed minimum of 2-year follow-up, with an average of 28.2±6.4 months. Threre were 66 cases in group A and 72 cases in group B. There was no significant difference in general information between the two groups(P>0.05). The mean operation time in group A and B was 48.2±7.3min and 56.2±10.7min, respectively, with a statistical significance(P<0.05). The hospitalization in group A and B was 4.2±0.9d and 4.1±1.1d, respectively, with no statistical significance(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 those of preoperation(P<0.05). There was no significant difference in postoperative VAS score for leg pain between the 2 groups, however, postoperative VAS score for back pain of group B was lower than that of group A, with a statistical significance(P<0.05). Transient dysesthesia occurred in 1 patient in each group. In the 1st year after surgery, recurrence occurred in 1 patient in group A and 7 patients in group B, with a statistical significance(P<0.05). In the 2nd year after surgery, recurrence occurred in 2 patients in group A and 1 patient in group B, with no statistical significance(P>0.05). According to the MacNab criteria, the satisfactory rate was 85.2% and 87.5% in group A and B, respectively, with no statistical significance(P>0.05). Conclusions: Clinical application of holmium laser in PELD for LDH is safe and effective, and it is favorable to the enhancement of operative efficiency, the relief of back pain and the reduction of recurrencerate in the early stage after operation.