Clinical Analysis Of Percutaneous Endoscopic Lumbar Discectomy Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion For Massive Lumbar Disc Herniation

Objective:To systematically evaluate the clinical outcomes of patients with single segmental massive lumbar disc herniation disease undergoing percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion.And by comparing the long-term follow-up results of the two methods,we can provide better surgical advice for the clinical treatment of massive lumbar disc herniation.Methods:In this study,144 patients with single segmental massive lumbar disc herniation were recruited from the department of orthopedics of China-Japan union hospital between October 2015 to October 2018.Among them 71 cases treated by PELD,there were 51 male and 20 women;45 cases L4-L5 section,21 cases L5~S1 section,5cases in another segment.The average age was 42.95±6.06.The average follow-up time was 28.01±10.99 months.73 patients were treated with MIS-TLIF,there were46 male and 17 women;49 cases L4-L5 section,16 cases L5~S1 section,8 cases in another segment.The average age was 41.68±5.72.The average duration of follow-up was 27.64±10.24 months.There were no significant differences between the two groups in gender,age,surgical segments,and average follow-up time.The total operative time,intraoperative blood loss,hospital stay and postoperative complications were obtained by referring to the medical records.Preoperative and postoperative visual analogue scale(VAS)(back),VAS(leg),modified Oswestry Disability Index(m ODI),Japanese orthopaedic association scores,and modified Macnab’s criterion at the last follow-up were used to evaluate the surgical efficacy.IBM SPSS 23.0 was used for the statistical analysis.Data are shown as mean ±SEM.The t test was used for the comparison of continuous variables,while Chisquare or Fisher’s exact test was used to evaluate measurement data.Variance analysis of single repeated measurement data was used to evaluate intra-group data.P values under 0.05 were accepted as statistically significant.Result:The operations of PELD group and MIS-TLIF group were all performed successfully,among which 5 cases were lost to follow-up.Compared with the MISTLIF group,the operative time,intraoperative blood loss and hospital stay in PELD group were significantly improved(P < 0.05).There was no statistical difference in the incidence of surgical complications between the two groups(P > 0.05).The postoperative recurrence rate of PELD group was higher than that of MIS-TLIF group,which was statistically significant(P < 0.05).Postoperative VAS score,JOA score and ODI score in both groups were significantly improved compared with those before surgery(P < 0.05).The postoperative VAS(back)score of PELD group was higher than that of MIS-TLIF group,with statistically significant difference(P < 0.05).Postoperative VAS(leg)score,JOA score,ODI score and modified Macnab’s criterion showed no significant difference between the two groups(P > 0.05).Conclusion:1.PELD and MIS-TLIF both have good surgical efficacy for the treatment of massive lumbar disc herniation,there are no significant difference in longterm effects.2.Compared with MIS-TLIF,PELD has the advantages of shorter operation time,less blood loss and earlier discharge from hospital.In addition,PELD can be performed under local anesthesia and has fewer postoperative complications,which can meet the requirements of short-term and rapid recovery of patients.3.High recurrence rate,long-term chronic postoperative low back pain,and insufficient decompression are still a shortcoming for the PELD.4.MIS-TLIF may be the better solution for patients with severe dural sac,nerve root compression,severe body dysfunction,and cauda equina syndrome.