A comparative study of two-dimensional navigation and X-ray fluoroscopy-guided percutaneous endoscopic transforaminal discectomy in the treatment of lumbar disc herniation

English Keywords:Lumbar disc herniation  Two-dimensional navigation  Percutaneous endoscopic transforaminal discectomy

English Abstract:

  【Abstract】 Objectives: To compare the early clinical effects between the two-dimensional(2D) navigation and X-ray fluoroscopy-guided percutaneous endoscopic transforaminal discectomy(PETD) in the treatment of lumbar disc herniation(LDH). Methods: A retrospective analysis was conducted on 80 LDH patients who were treated with PETD from January 2022 to December 2022. 40 patients were treated with 2D navigation-guided PETD(2D navigation group), including 24 males and 16 females, aged 28-55 years(40.5±7.7 years); 10 cases were of L3/4, 18 cases were of L4/5, and 12 cases were of L5/S1. The other 40 patients were treated with X-ray fluoroscopy-guided PETD(X-ray fluoroscopy group), including 22 males and 18 females, aged 28-54 years(41.7±7.7 years); 7 cases were of L3/4, 19 cases were of L4/5, and 14 cases were of L5/S1. There were no statistical differences in age, gender, and surgical segment between the two groups(P>0.05). The patients were followed up for 11-16 months(13.3±1.2 months). The operation time, intraoperative bleeding volume, intraoperative fluoroscopy times, and complications of the two groups were analyzed. Visual analogue scale(VAS) scores of leg pain were evaluated before surgery, on 3d after operation, and at 12 months after surgery, and Oswestry disability index(ODI) was evaluated before surgery and at 1 month and 12 months after surgery. The clinical efficacy was evaluated using the modified MacNab efficacy evaluation criteria at 12 months after surgery. Results: All the patients successfully underwent the operation. The operation time in the 2D navigation group was 40.6±5.4min, the intraoperative bleeding volume was 10.4±2.1mL, and the fluoroscopy times were 2.4±0.5; The operation time in the X-ray fluoroscopy group was 58.7±4.0min, the intraoperative bleeding volume was 11.3±2.4mL, and the fluoroscopy times were 10.6±4.0. The operation time was less and fluoroscopy times were fewer in the 2D navigation group than those in the X-ray fluoroscopy group, and the differences were statistically significant(P<0.05). There was no statistical difference between the two groups in intraoperative bleeding(P>0.05). There were 2 cases in the 2D navigation group and 3 cases in the X-ray fluoroscopy group occurred short-term postoperative numbness, and the incidence was not statistically different between groups(P>0.05). The VAS scores of leg pain and ODI in both groups at various time points after surgery were significantly lower than those before surgery, and the differences were statistically significant(P<0.05). The VAS score of leg pain in the 2D navigation group was lower than that in the X-ray fluoroscopy group on 3d after surgery, and the difference was statistically significant(P<0.05). There were no significant differences between the two groups in VAS scores of leg pain and ODI at other time points during follow-up(P>0.05). The final follow-up modified MacNab efficacy evaluation: 36 cases were excellent, 3 cases were good, and 1 case was fair in the 2D navigation group, and the excellent and good rate was 97.5%(39/40); 30 cases were excellent, 8 cases were good, and 2 cases were fair in the X-ray fluoroscopy group, and the excellent and good rate was 95%(38/40), there was no statistical difference in the excellent and good rate between the two groups(P>0.05). Conclusions: Both 2D navigation and X-ray fluoroscopy-guided PETD can achieve good clinical results in treating LDH, and 2D navigation guided PETD needs shorter operation time and fewer fluoroscopy times.