A Comparative Short-term Effects Study Of PTED And MED In The Treatment Of Lumbar Disc Herniation

Objective:By comparing the short-term effects of percutaneous transforaminal endoscopic discectomy(PTED) and microendoscopic discectomy(MED) in the treatment of lumbar disc herniation(LDH), we discuss each of the best indications.Methods:1. A retrospective study was performed on 90 patients who were diagnosed as single lumbar disc herniation from July 2013 to February 2014 were divided into 2 groups according to the operative method. There are 45 cases in the MED group,26 males and 19 females; there are 45 cases in the PTED group,27 males and 18 females.2. By recording every patient of the length of operative incision, the blood loss, the operation time, the frequency of intraoperative X-ray exposure, the period that they were kept in bed postoperatively and the hospitalization duration, and using the Visual Analogue Scale(VAS) and Oswestry Disability Index(ODI) regularly to evaluate the clinical outcomes before and after operation, we did the comparative research between 2 operative methods.Results:1. The mean average length of operative incision in the PTED group was 6.9 mm, an average blood loss of 12.4 ml, a mean operation time was 85.6 min, a mean frequency of intraoperative X-ray exposure for the patients was 24.6, Postoperatively they were kept in bed for a mean period of 6.1 h, with an average hospitalization duration of 2.8 d. While for the patients in the MED group, The mean average length of operative incision was 17.9 mm, an average blood loss of 39.8 ml, a mean operation time was 49.6 min, a mean frequency of intraoperative X-ray exposure for the patients was 2.5, Postoperatively they were kept in bed for a mean period of 80.6 h, with an average hospitalization duration of 6.3 d.2. The PTED group was superior to the MED group on the length of operative incision, the blood loss, the period that they were kept in bed postoperatively and the postoperative hospitalization duration, and the differences between the 2 groups were statistically significant(P<0.05). The frequency of intraoperative X-ray exposure was less and the operation time was shorter in the MED group than those in the PTED group, and the differences between the 2 groups were statistically significant(P<0.05).3. The VAS and ODI scores were significantly improved postoperatively in both groups when compared with those preoperatively(P<0.05). In a short period after surgery, back pain VAS scores in the PTED group were lower than that in the MED group, the rates of improvement in back pain VAS scores in the PTED group were better than that in the MED group, and the differences between the 2 groups were statistically significant(P<0.05). In terms of 3 months and 6 months after operation back pain VAS scores in the 2 groups, and postoperative follow-up of leg pain VAS scores and ODI scores, and the rates of improvement in leg pain VAS scores and in ODI scores, the differences between the 2 groups were not statistically significant(P<0.05).Conclusion:Both PTED and MED are effective minimally invasive surgical procedure in the treatment of lumbar disc herniation. Compared with MED, PTED has the advantages of less invasion, less blood loss, quicker postoperative recovery and so on. Compared with PTED, MED has the advantages of less X-ray harm, shorter operation time and so on.