Clinical effect analysis of percutaneous transforaminal endoscopic discectomy combined with platelet-rich plasma repair for young adults with lumbar disc herniation

English Keywords:Lumbar disc herniation  Percutaneous transforaminal endoscopic discectomy  Lumbar disc degeneration  Minimally invasive surgery  Platelet-rich plasma  Repair

English Abstract:

  【Abstract】 Objectives: To investigate the clinical safety and efficacy of percutaneous transforaminal endoscopic discectomy(PTED) combined with platelet-rich plasma(PRP) repair in the treatment of lumbar disc herniation (LDH) in young adults. Methods: The clinical data of 120 LDH patients who met the inclusion and exclusion criteria from January 2017 to December 2019 were retrospectively analyzed. Among them, group A(n=40) underwent endoscopic treatment only, group B(n=42) underwent endoscopic treatment combined with one-step centrifugation PRP and group C(n=38) underwent endoscopic treatment combined with two-step centrifugation PRP. The visual analogue scale(VAS), Japanese Orthopedic Association(JOA) score for lumbar spine and Oswestry disability index(ODI) were recorded preoperatively, and at 7d, 3, 6 and 12 months postoperatively. Spinal canal cross-sectional area(SCSA), signal intensity ratio(SIR) between nucleus pulposus and cerebrospinal fluid, disc height index(DHI) and disc Pfirrmann grading were measured preoperatively, and at 6 and 12 months postoperatively and the final follow-up. The improvement rate of JOA score was used to evaluate the clinical efficacy at 12 months postoperatively. Results: The patients were followed up for 24-33(28.02±2.19) months and no serious complications such as intervertebral space infection, nerve root tear or fracture, and segmental instability occurred during the study. The postoperative VAS score, JOA score and ODI of the three groups were all significantly improved compared with those before operation(P<0.05). A pairwise comparison of VAS, JOA and ODI between the three groups showed statistic differences at 7d and 3 months postoperatively(P<0.05); and there were significant differences between groups A and C as well as between groups B and C(P<0.05) at 6 months postoperatively, but there was no statistical difference between group A and group B(P>0.05). At final follow-up, there were significant differences in SCSA, SIR and disc Pfirrmann grading between group A and B as well as between group A and C(P<0.05), but there was no significant difference between group B and group C(P>0.05). In addition, DHI did not show a significant difference between the three groups before operation, at postoperative 6 and 12 months and final follow-up(P>0.05). According to the JOA score improvement rate, the excellent and good rate of JOA in group A, group B and group C was 92.5%, 95.2% and 97.4%, and with no statistically significant difference(P>0.05), respectively at postoperative 12 months. Conclusions: PTED combined with PRP repair in the treatment of LDH in young adults is safe and effective, and can delay the degeneration of intervertebral discs to a certain extent.