Comparison Of Outcomes Of Intervertebral Foramen And Repair Of Annulus Fibrosus For Lumbar Disc Herniation

Objective:To evaluate the safety and short-term clinical efficacy of the excision of nucleus pulposus combined with fibrous suture via the Vista channel system(Vista)and percutaneous transforaminal nucleus pulposus excision(PTED)in the treatment of lumbar disc herniation(LDH).Methods:During the same period,we retrospectively analyzed the data of42 patients with single-segment LDH who underwent nucleus pulposus excision with annulus fibrosus suture via the Vista channel system and PTED from March 2017 to October 2017 in the First Affiliated Hospital of Guangxi Medical University.They were divided into two groups,among which group A(Vista channel system excision of nucleus pulposus combined with annulus fibrosus suture)had 14 patients,10 males and 4 females,aged 20-42 years(30.29±6.69);Group B(PTED)had 28 patients,14 males and 14 females,aged 18-47(32.50±8.75).The operative time,incision length,blood loss,postoperative hospital stay,Visual analogue scores(VAS),Oswestry disability index(ODI),and MacNab criteria efficacy were recorded in two groups.Complications and recurrence were also observed.Results: There was no difficult difference in operation time,bloodloss,andpostoperative hospital stay between the two groups(P>0.05),Incision length was statistically significant(P < 0.05).There were statistically significant differences in the VAS scores of the low back pain and the ODI scores of preoperative and postoperative within two groups(P < 0.05).There were statistically significant differences in the VAS scores of the low back pain and the ODI scores of preoperative and postoperative between two groups(P <0.05).There was no recurrence in the Vista suture group.There was one case of recurrence in the PTED group and reoperation,the recurrence rate was 3.6%.No serious complications such as cerebrospinal fluid leakage,infection,and nerve root injury occurred in both groups.Evaluation of short-term efficacy using MacNab criteria: 12 cases were excellent in the Vista suture group,1 cases were good,1 case was fair,and the excellent and good rate was 92.30%;PTED group was excellent in 23 cases,good in 3 cases,fair in 2,and good rate was 92.85%.Conclusion:The curative effect of nucleus pulposus excision combined with fibrous suture via Vista channel system in the treatment of single-stage lumbar disc herniation is similar to PTED.However,the PTED has a small visible range,surgical skills of high requires,a steep learning curve,and a high risk of recurrence after surgery.Vista suturing can meet the minimally invasive treatment while reducing the recurrence rate and is easy to operate.It is another option for minimally invasive surgery for LDH.This study still requires further large-scale randomized studies and long-term follow-up.