Comparison Of The Mid-and Long-term Clinical Outcomes Of Microendoscopic Discectomy And Posterior Modified Transforaminal Lumbar Interbody Fusion In The Treatment Of Single Segment Lumbar Disc Herniation

Objective: To compare the mid-and long-term clinical outcomes of single-segment lumbar disc herniation in middle-aged patients with microendoscopic discectomy(MED)and posterior modified transforaminal lumbar interbody fusion(modified TLIF).Methods:The data of MED and modified TLIF operated by the same chief physician in our department from September 2009 to September 2014 were analyzed retrospectively.There were 143 patients with a follow-up time of more than 60 months,including 63 MED patients(MED group)and 80 modified TLIF patients(modified TLIF group).The visual analogue score(VAS),Oswestry dysfunction index(ODI),the excellent and good rate of modified macnab grading,the decrease rate of adjacent intervertebral space height,the maximum flexion activity of lumbar vertebrae,and the degeneration of adjacent segments were compared between the two groups.Results: The VAS scores of the patients in the modified TLIF group at the last follow-up were higher than those in the MED group(P<0.05).the other scores between the two groups were not statistically different at the same time point(P >0.05).At 2 years postoperatively,the excellent and good rate of modified MacNab was 92.1% in MED group and 85.0% in modified TLIF group.The excellent and good rate of MED group was 90.5% at the last follow-up,and 83.8% in modified TLIF group.There was no statistical difference between the two groups(P>0.05).At the last follow-up,the rate of decrease in the adjacent intervertebral space was smaller in the MED group than in the modified TLIFgroup(P<0.05),and the maximum flexion activity in the lumbar vertebra was greater(P<0.05).There was no significant difference in the incidence of adjacent segment degeneration(4.8% in the MED group and 7.5% in the modified TLIF group,P>0.05).Conclusion: MED surgery for middle-aged patients with single-segment lumbar disc herniation can achieve effective mid-and long-term clinical efficacy comparable to modified TLIF surgery,but MED surgery can better relieve postoperative lumbar back discomfort,preserve the height of adjacent intervertebral space and lumbar flexion activity.