Clinical efficacy of visual working channel assisted percutaneous transforaminal endoscopic discectomy in treating lumbar disc herniation

English Keywords:Lumbar disc herniation  Percutaneous transforaminal endoscopic discectomy  Visual working channel  Minimally invasive

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of visual working channel assisted percutaneous transforaminal endoscopic discectomy(PTED) in treating lumbar disc herniation(LDH). Methods: The medical records of 141 LDH patients who underwent PTED between June 2022 and June 2023 were retrospectively analyzed. The patients were divided into two groups of the visual group consisting of 68 cases(38 males and 30 females, with an average age of 48.0±15.9 years), and the transparent visual working channel was applied in PTED; And the traditional group including 73 cases(46 males and 27 females, with an age of 47.6±16.9 years), and the traditional metal working channel was applied in PTED. There was no statistical difference in the general data(gender, age, etc) between the two groups(P>0.05). The operative time, intraoperative blood loss, postoperative length of hospital stay, and complication occurrence were compared between the two groups. The degree of low back pain was assessed using the visual analogue scale(VAS) score for pain, and the lumbar spine function was assessed using the Oswestry disability index(ODI) before operation, at one week and, 1, 3, and 6 months after surgery, and final follow-up, respectively. The MacNab criteria were used to assess the clinical outcomes of patients at the final follow-up. Results: The operative time, intraoperative blood loss, and postoperative length of hospital stay in the visual group was all less than those in the traditional group(71.06±8.97min vs 75.16±9.47min, 14.19±2.66mL vs 15.58±2.81mL, 2.16±0.96d vs 2.54±1.23d), and the differences were statistically significant(P<0.05). The VAS scores and ODI one week after surgery, 1, 3, and 6 months after surgery, and at the final follow-up were significantly improved compared with the preoperative values in both groups(P<0.05). At the final follow-up, the VAS score and ODI in the visual group were significantly improved compared with those in the traditional group[1.18±0.39 vs 1.27±0.45, (3.97±1.67)% vs (4.54±1.55)%], and the differences were statistically significant(P<0.05). According to the MacNab criteria at the final follow-up, 53 cases in the visual group were excellent, 12 cases were good, and 3 cases were possible, with an excellent and good rate of 95.6%; 52 cases in the traditional group were excellent, 15 cases were good, 4 cases were possible, and 2 cases were poor, with an excellent and good rate of 91.8%(P>0.05). No surgery-related complications occurred in the visual group and 4 cases of nerve root irritation signs and 2 cases of postoperative recurrence occurred in the traditional group; The complication rate of the traditional group was 8.2%, and the complication rate of the visual group was lower than that of the traditional group, and the difference was statistically significant(P<0.05). Conclusions: The visual working channel assisted PTED has the advantages of short operative time, little intraoperative bleeding, fast postoperative recovery, and few complications in treating LDH.