Clinical effectiveness of large channel interlaminar endoscopic lumbar discectomy in the treatment of highly downward migrated-lumbar disc herniation

English Keywords:Lumbar disc herniation  Highly downward migration  Large channel endoscopy  Interlaminar endoscopic lumbar discectomy  Fenestration

English Abstract:

  【Abstract】 Objectives: To explore the clinical effectiveness of large channel interlaminar endoscopic lumbar discectomy in the treatment of highly downward migrated-lumbar disc herniation(HDM-LDH). Methods: A retrospective analysis was conducted on the clinical data of patients with single-level HDM-LDH who underwent surgical treatment at our hospital between December 2020 and June 2024. Among them, 83 cases treated with large channel interlaminar endoscopic lumbar discectomy(56 males and 27 females, age range 16-79 years, average age 42.6±13.3 years) with a follow-up period of 23.7±6.6 months, were included in the endoscopy group. A control group of 73 cases underwent mini-open fenestration discectomy(49 males and 24 females, age range 18-72 years, average age 39.5±13.4 years) with a follow-up period of 23.1±5.8 months, were included in the fenestration group. There was no statistical differences between the two groups in age, gender or follow-up period(P>0.05). The operative time, incision length, intraoperative fluoroscopy frequency, intraoperative blood loss, postoperative drainage, and postoperative hospital stays were compared between the two groups. The visual analogue scale(VAS) score for pain and Oswestry disability index(ODI) were recorded preoperatively, at 3 months and 12 months postoperatively, and final follow-up visit. At preoperation, postoperative 12-month, and final follow-up, the anterior-posterior diameter of the intervertebral disc and cross-sectional area of the dural sac were measured to evaluate the disc removal and spinal decompression effects. At final follow-up, clinical efficacy was evaluated by the modified MacNab criteria. Results: No statistical difference was observed in operative time between the two groups(P>0.05). The endoscopy group was shorter in incision length(1.3±0.2cm vs 4.5±0.5cm), less in intraoperative blood loss(19.0±7.5mL vs 65.3±41.1mL), and shorter in postoperative hospital stays(2.8±0.6d vs 5.1±0.8d) than the fenestration group, with statistically significant differences(P<0.05). The number of intraoperative fluoroscopy times was higher in the endoscopy group(2.4±0.5 vs 1.3±0.4, P<0.05). The fenestration group had a postoperative drainage of 40.0±13.1mL, while no drainage was required in the endoscopy group. Both groups showed significant improvements in VAS score, ODI, anterior-posterior diameter of the intervertebral disc and the cross-sectional area of the dural sac at all postoperative time points(P<0.05), with no significant differences between the two groups at the same time points(P>0.05). At final follow-up, the clinical efficacy according to the modified MacNab criteria showed an excellent-good rate of 92.7% in the endoscopy group and 91.8% in the fenestration group, with no significant difference(P>0.05). Conclusions: For the treatment of HDM-LDH, large channel interlaminar endoscopic lumbar discectomy can offer advantages such as smaller trauma, less intraoperative blood loss, shorter postoperative hospital stays, and no need for drainage postoperatively, which can achieve clinical effectiveness comparable to mini-open fenestration discectomy.