Clinical Study Of Lumbar 4/5 Disc Herniation Treated By Transforaminal And Interlaminar Approach Under Spinal Endoscopy

Objective To elucidate percutaneous endoscopic interlaminar discectomy,The clinical efficacy of PEID and percutaneous endoscopic transforaminaldiscectomy（PETD）in the treatment of lumbar 4/5 disc herniation provides clinical basis for the selection of surgical protocols in patients with lumbar4/5 disc herniation.Methods Patients with lumbar 4/5 disc herniation treated by two approaches in spinal Surgery Department of Enshi Tujia and Miao Autonomous Prefecture Central Hospital from October 1,2017 to August 31,2020 were selected as research subjects.A total of 128 patients were screened out according to inclusion and elimination criteria,including 66 patients in PEID group and 62 patients in PETD group.The general information,incidence of surgical complications and lumbar instability,VAS score and ODI index before and the first,third,sixth,and12 th month after operation were compared and analyzed between the two groups.The clinical efficacy of the two groups after operation was evaluated by clinical modified Mac Nab standard.Results（1）there were no significant differences in age,sex and protrusion type between the two groups（P>0.05）and the two surgical procedures were performed by the same spine surgeon,which were comparable.（2）The operation time of PEID group was（61.47±4.19）min,PETD group was（88.20±6.51）min,the difference was statistically significant（P<0.05）.PEID group（28.59±8.89）ml,PETD group（74.92±9.94）m L,the difference was statistically significant（P<0.05）.The amount of nucleus pulposus removed was（3.90±0.34）g in PEID group and（2.74±0.36）g in PETD group,and the difference was statistically significant（P<0.05）.PEID group（3.97±0.25）times,PETD group（5.91±0.39）times,the difference was statistically significant（P<0.05）.（3）VAS scores at the first,third,sixth,and 12 th month after surgery and ODI index at 1 year after surgery were significantly lower than those before surgery（P<0.05）.VAS score and ODI index of first month,third month,sixth month and 12 th months after surgery in PEID group were lower than those in PETD group（P<0.05）.The ODI index in PEID group was lower than that in PETD group at first,third and sixth month postoperatively（P<0.05）,and there was no statistical difference in ODI index between PETD group and PEID group one year after operation（P>0.05）.In the last follow-up,the clinical improved Mac Nab standard index was used to evaluate and describe the efficacy.The excellent and good rate of PEID group was 97.0%（64/66）.The excellent and good rate of PETD group was 95.2%（59/62）,and the difference was not statistically significant.Conclusion PEID and PETD can effectively complete the diagnosis and treatment of lumbar 4/5 disc herniation.Compared with PETD,PEID has the characteristics of shorter operation time,less bleeding,more nucleus pulposus removal,fewer fluoroscopy times,better postoperative recovery and higher patient satisfaction,which has better clinical application value.