The Strategy And Early Clinical Outcome Of Targeted Percutaneous Full-endoscopic Lumbar Discectomy Through Interlaminar Approach

Objective: To analyze the surgical targeted strategy,safety and clinical outcome of minimally invasive targeted percutaneous endoscopic lumbar discectomy(PELD)through interlaminar approach.Methods: A retrospective review was performed on 69 patients(29 males and 40females)with lumbar disc herniation between August 2013 and September 2015.The average age was 45.4 years old.Disc herniation was divided into three types according to position of herniated disc related to compressed nerve root: shoulder type,axilla type,ventral type.All 69 patients were treated with targeted percutaneous endoscopic lumbar discectomy through different targeted surgery.The shoulder approach was selected for shoulder type,the axilla approach was selected for axilla type and the ventral approach was selected for ventral type.The time of operation and the volume of removal intervertebral disc were recorded.The pain visual analogue scale(VAS),Oswestry disability index(ODI)and modified Macnab score were used to evaluate the curative effect.The VAS scores,ODI scores before operation and at 1,3,6 and 12 months after surgery were recorded.Lumbar MRI was used to evaluate the removal of herniation and decompression of nerve root within one week after operation.Results: All operation were successfully completed.Surgical bleeding was not observed and no complications occurred during the operation.The mean operation time was 88 min.The mean quantities of resectable nucleus pulposus was 2.8ml.The lumbar MRI was revealed that the nucleus pulposus was completely removed and the nerve root decompression was sufficient.The follow-up period was 12 months in 69 patients.The mean VAS score improved from(7.46 ± 0.80)at preoperation to(1.27 ± 0.61)at last follow-up.The mean ODI score was improved from(67.95±4.59)% to(13.00±3.65)%.The postoperative VAS score and ODI score in each point of time were significantly reduced compared with the preoperative assessment,and the difference was statistically significant(P<0.05).Macnab score was excellent in 54 cases,good in 12 cases and fine in3 cases.The excellent and good rate was 95.6%.Conclusion: By choosing the shoulder approach,axilla approach or ventral approach properly,targeted percutaneous full-endoscopic lumbar discectomy through interlaminar approach is a safe,rational and effective minimally invasive spine surgery technique with satisfied clinical short-term outcomes.