| BackgroundLumbar disc herniation（LDH）is a common clinical spinal disease.After the degeneration of the nucleus pulposus of the lumbar intervertebral disc,the nucleus pulposus of the intervertebral disc protrudes into the posterior spinal canal from the rupture of the annulus fibrosus.It causes mechanical compression and/or aseptic inflammatory stimulation to adjacent nerve roots or dural sac,resulting in clinical symptoms characterized by low back pain and lower extremity numbness and pain.Some patients have poor remission after conservative treatment and still require surgical treatment.In recent years,under the guidance of the concept of minimally invasive surgery,minimally invasive techniques have developed rapidly in orthopaedics,and percutaneous endoscopic lumbar discectomy（PELD）has been widely used in clinical practice.Divided into percutaneous endoscopic transforaminal discectomy（PETD）and percutaneous endoscopic interlaminar discectomy（PEID）.To explore the clinical efficacy and indications of two different approaches in the treatment of lower lumbar intervertebral disc herniation with transforaminal endoscopic techniques is of great significance for the clinical promotion of this technique.ObjectiveThe clinical efficacy of PETD and PEID in the treatment of lower lumbar disc herniation was retrospectively analyzed and compared,and the clinical application indications and technical characteristics of PETD and PEID were discussed and summarized.MethodsAccording to the inclusion and exclusion criteria,105 LDH patients who underwent PELD treatment in our hospital from September 2019 to March 2021 were retrospectively analyzed,and they were divided into PETD group and PEID group according to different surgical approaches.A total of 56 patients in the PETD group:32 males and 24 females;aged 21 to 75 years,with an average age of 51.07±13.29 years;35 cases in L4/5 segment,21 cases in L5/S1 segment;average course of disease 13.21±5.59 moon.A total of 49patients in the PEID group:26 males and 23 females;aged 19 to 86 years,mean age46.76±13.18 years;16 cases in L4/5 segment,33 cases in L5/S1 segment;average course of disease 13.59±6.32 moon.The perioperative clinical data of the two groups were recorded,and the operation time,blood loss,times of fluoroscopy and hospital stay were compared between the two groups.To compare LDH classification between PETD and PEID,in order to evaluate the best surgical approach;Visual Analogue Score（VAS）and Oswestry Disability Index（ODI）were recorded before and at 1,3,12 months postoperatively,and at the last follow-up.The VAS score was used to evaluate the relief of low back and leg pain,and the ODI index was used to evaluate the postoperative lumbar function recovery.At the last follow-up,the Mac Nab score was used to evaluate the excellent and good rate,and the overall surgical efficacy was evaluated.The incidence of complications and postoperative recurrence were recorded and compared between the two groups.Results1.Except for intervertebral disc herniation,there was no statistical difference in gender composition ratio,age and disease course between the two groups（P>0.05）;The operative duration and the number of intraoperative X-ray fluoroscopy in PEID group were lower than those in PETD group,and the differences between groups were statistically significant（P<0.05）.There was no significant difference in intraoperative blood loss and postoperative hospital stay between the two groups（P>0.05）;2.PETD approach has obvious advantages in the treatment of central and supra-shoulder LDH,and the difference between groups is statistically significant（P<0.05）.PEID approach is more suitable for the treatment of paracentral,highly displaced and axillary LDH.The difference between the groups was statistically significant（P<0.05）;3.The VAS score and ODI index of low back and leg pain in the two groups were significantly improved at 1 month,3 months,12 months after operation and the last follow-up compared with those before operation,and the difference was statistically significant（#P<0.05）;There was no significant difference in the two indicators between the groups before or after the operation at the same time point（P>0.05）;4.The Mac Nab score was used to evaluate the overall curative effect at the last follow-up.The excellent and good rate was 89.47%in the PETD group and 86.67%in the PEID group,with no significant difference between the two groups（~2=0.226;P=0.635）;5.All 105 patients in the two groups successfully completed the operation without serious complications.There was no significant difference in the total incidence of complications and postoperative recurrence rate between the two groups（both p>0.05）;Although there was no significant difference in the total complication rate between the PETD group and the PEID group,the incidence of nerve injury and dural tear in the PEID group was significantly higher than that in the PETD group（~2=4.302,P=0.038）.Conclusion1.Both PETD and PEID can achieve satisfactory clinical results in the treatment of lower lumbar disc herniation（L4/5 and L5/S1）.Compared with PETD,PEID also has the advantages of shorter operation time,fewer fluoroscopy times,and no bony obstruction.However,the incidence of intraoperative nerve injury and dural tear was significantly higher in PEID than in PETD.2.PETD is suitable for intervertebral disc herniation with supra-shoulder and centtral LDH;while PEID surgery has obvious advantages in treating paracentral,axillary,high degree of displacement LDH or with obvious bony blocking LDH. |
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