The efficacy of accurate foraminoplasty technique with visualized chisel under full-visualized spinal endoscopy in treating lumbar disc herniation

English Keywords:Lumbar disc herniation  Accurate foraminolplasty technique  Full visualized spinal endoscopy  Spinal minimally invasive surgery

English Abstract:

  【Abstract】 Objectives: To explore the clinical efficacy of applying the accurate foraminoplasty technique with visualized chisel under full-visualized spinal endoscopy(FVSE) in the treatment of lumbar disc herniation(LDH). Methods: The clinical data of 143 patients with single-segment LDH undergone operative treatment under FVSE in our hospital between July 2020 and December 2022 were retrospectively analyzed. 63 cases were treated with the accurate framinoplasty technique with visualized chisel(Chisel group), consisting of 37 males and 26 females, aged 45.3±15.1 years(range, 19-68 years), and body mass index(BMI) was 22.3±1.8kg/m2(range, 19.2-25.6kg/m2); Operative segment: L2/3 in 8 cases, L3/4 in 15 cases, L4/5 in 25 cases, L5/S1 in 15 cases; LDH anatomical classification: 20 cases of bulging type, 22 cases of protruding type, 12 cases of prolapsing type, and 9 cases of free type; LDH location classification: 10 cases of central type, 21 cases of paracentral type, 24 cases of foraminal type, and 8 cases of extreme lateral type. The other 80 cases were treated with trepan technique(Trephine group), consisting of 46 males and 34 females, aged 43.8±14.1 years(range, 19-68 years), BMI was 21.5±1.6kg/m2(range, 19.2-24.1kg/m2); Operative segment: L2/3 in 9 cases, L3/4 in 17 cases, L4/5 in 30 cases, and L5/S1 in 24 cases; LDH anatomical classification: 23 cases of bulging type, 31 cases of protruding type, 19 cases of prolapsing type, 7 cases of free type; LDH location classification: 13 cases of central type, 27 cases of paracentral type, 29 cases of foraminal type, and 11 cases of extreme lateral type. The operative time, total intraoperative bleeding, number of fluoroscopies, and hospitalization time were recorded and compared between the two groups. The intervertebral foraminal area before operation, at 3d after operation and final follow-up, visual analogue scale(VAS) score, Oswestry disability index(ODI), and Japanese Orthopedic Association(JOA) score before operation, at postoperative 3d, 1 month, 6 months, and final follow-up were recorded and compared between the two groups. The clinical efficacy was assessed by MacNab criteria at the final follow-up. Results: The operative time, total intraoperative bleeding and number of fluoroscopies were 84.6±14.3min, 23.1±8.3mL and 2.9±1.6 times in the chisel group and 86.6±15.1min, 32.2±6.4mL and 5.6±1.0 times in the trephine group, and the intraoperative bleeding and number of fluoroscopies in the chisel group were less than those in the trephine group(P＜0.05), while no significant difference was there in the operative time between the two groups(P>0.05). 143 patients were followed up for 9-20 months. The VAS scores, JOA scores and ODI at 3d, 1 month, 6 months and the final follow-up of both groups showed significant improvements compared with the preoperative data, respectively(P<0.05), and there was no statistical difference between the two groups at the same time points(P>0.05). The intervertebral foramina area at 3d postoperatively and at the final follow-up in both groups increased than that before surgery(P<0.05), and the rate of change in the intervertebral foramina area at 3d postoperatively and at the final follow-up in the trephine group was greater than that in the chisel group(P<0.05). At the final follow-up, according to the MacNab standard, chisel group was excellent in 43 cases, good in 18 cases, moderate in 2 cases, and poor in 0 case, with an excellence and good rate of 96.8%, while the trephine group was excellent in 57 cases, good in 20 cases, moderate in 3 cases, and poor in 0 case, with an excellence and good rate of 96.3%. There was no statistical difference between the two groups in terms of excellent and good rate according to MacNab criteria(P>0.05). Conclusions: The clinical efficacy of accurate foraminoplasty technique with visualized chisel is similar to foraminalplasty with trephine under FVSE, but foraminoplasty technique with visualized chisel reduces the number of fluoroscopies and bleeding volume.