The Clinical Study Of Percutaneous Transforaminal Endoscopic Discectomy For Lumbar Disc Herniation

Objective:To investigate the the location of percutaneous puncture by radiographs, which can provide the useful data for the operation.And to compare the clinical effectiveness of percutaneous transforaminal endoscopic discectomy(PTED) with microendoscopic discectomy(MED).Methods:1. Desiding the vertebral puncture model ,and divide the surface of the disc into 7 regions.Taking the anterioposterior and lateral radiographs of the model to analyze the correlation of puncture needle's radiographs in each region.2. In this prospective randomized controlled study,a total of 60 patients preoperatively diagnosed as single lumbar disc herniation from December 2007 to June 2008,were randomly divided into two groups, 30 patients in each.The Oswestry disability index (ODI), Visual analogue scale (VAS), modified MacNab criteria were employed to measure the clinical outcomes.Result:1. There are some correlations between the anterioposterior and lateral radiographs. The percutaneous puncture location software are developed by the anterioposterior and lateral radiographs.2. All the procedures were performed successfully.There was no significant difference between the two groups of disc herniation types,operative time, fellow-up time and complication rate. But the average skin incision of PTED was (0.7±0.2) cm, with an average blood loss was (7±2) ml and a mean postoperative stay of 1 day. The average skin incision of MED was (1.9±0.3)cm, with an average blood loss was (48±13) ml and a mean postoperative stay of nearly 4 days(range, 3～6days). According to the modified MacNab criteria, 90% of patients in PTED group showed excellent or good outcomes while 93% of patients in MED group showed excellent or good outcomes. There is no significant difference of between the the two groups(p>0.05). The improvement in VAS and ODI were statistically significant in the two groups (p<0.05).Conclusion:1. There some techniques in the process of percutaneous puncture step. By using C-arm and the software properly,the achievement ratio of puncture and the surgical efficiency will be improved.2. According to the indications,the short surgical outcome of PTED for lumbar disc herniation is similar to MED, if the patients are selected strictly. But PTED has the advantages of smaller incision, less bleeding, less tissue trauma and quicker recovery. It is a safe and efficacious minimally invasive surgical technique.