Comparison Of The Efficacy Of Two Types Of Percutaneous Endoscopic Treatment For Lumbar Disc Herniation Via Interlaminar Approach

Objective To compare the effect of two kinds of Percutaneous endoscopic interlaminar discectomy treatment for lumbar disc herniation.Method The clinical data of 87 patients who received PEID due to LDH and met the selection criteria admitted to Zigong Fourth People’s Hospital Affiliated to Southwest Medical University from September 2020 to February 2022.41patients received an external and superior extended interlaminar approach and46 patients received an external and inferior extended interlaminar approach by the surgical method.There were no significant differences in gender,age,BMI,distribution of responsible segments,type of disc herniation,preoperative VAS score,ODI index between the two groups(P>0.05).Meanwhile,all patients had soft herniation,which were comparable.The operation time,VAS-lumber,VAS-leg and ODI function index of the two groups were recorded and compared.The clinical efficacy was evaluated by modified Macnab standard,and the occurrence of complications were observed.Result All patients successfully completed the operation,and there was no statistical significance in the operation time(P>0.05).The VAS-lumber,VAS-leg and ODI index of the two groups were statistically different at each time point after surgery(P<0.05),except for 24h postoperative VAS-lumber(P>0.05).There were no significant differences in the above indexes at each time point after surgery between groups(P>0.05).According to the modified Macnab standard,there was no significant difference(χ~2=0.263,P=0.967).There were no complications such as nerve root rupture and dural sac tear in two groups.In the face of central disc herniation,the incidence of postoperative paresthesia or aggravation in the outer lower group was statistically significant compared with the outer upper group(P<0.05).In the face of disc prolapse dissociation,there was also a statistically significant difference in the incidence of residual nucleus pulposus between the outer upper and outer lower groups(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(χ~2=0.066P=0.798).Conclusion By comparing the clinical efficacy of two kinds of Percutaneous endoscopic interlaminar discectomy treatment for lumbar disc herniation,it is found that both of them can better relieve back and leg pain,and are effective and safe surgical methods for the treatment of lumbar disc herniation.The extended interlaminal approach can better remove the central disc herniation,with less intraoperative nerve stretching and compression,and less incidence of postoperative paresthesia or aggravation.However,in the face of migrate disc herniation,it is likely to lead to residual nucleus pulposus.The extended interlaminae approach can better remove the prolapsed free nucleus pulposus tissue,but due to the anatomical structure of the nerve root,it is more likely to push the nerve root when facing the central disc herniation,resulting in a higher incidence of postoperative paresthesia or exacerbation.