Comparative Study Of The Percutaneous Endoscopic Interlaminar Approach And Transforaminal Approach For Calcified Lumbar Disc Herniation

Objective:This research aims to compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy(PEID)and percutaneous endoscopic transforaminal discectomy(PETD)for calcified lumbar disc herniation(CLDH)and explore on the surgical access options of percutaneous endoscopic lumbar discectomy(PELD)for the treatment of L5-S1 CLDH.Methods:A retrospective analysis of 42 patients with L5-S1 CLDH treated by percutaneous endoscopic surgery in our hospital from August 2016 to December 2019.All patients underwent lumbar X-ray,CT and MRI examinations before and after the operation.All patients were diagnosed with single-segment CLDH.All patients were divided into two groups according to the surgical method,one group was the PEID group underwent PEID(24 cases,14 males and 10 females)and the other group was the PETD group underwent PETD(18 cases,10 males and 8females).The general information of the PEID group and the PETD group of patients(gender,age,follow-up time,body mass index(BMI),course of disease),preoperative visual analog scale(VAS)and preoperative Oswestry function Disability index(Oswestry disability index,ODI)was compared.The clinical efficacy of the PEID group and the PETD group(VAS scores at 1 day after surgery,1 month after operation,3 months after surgery,6 months after operation,and 12 months after operation;the ODI index at 3 months after operation,6months after operation and 12 months after surgery;the modified Mac Nab efficacy evaluation standard at the last follow-up)was compared.Perioperative indicators(operation time,intraoperative fluoroscopy times,blood loss,postoperative hospital stay and complications)of the PEID group and the PETD group were compared.Results:A total of 42 patients in the PEID group and PETD group completed the operation,including 24 males and 18 females.The mean age,BMI,duration of disease and follow-up time of 42 patients were37.40±8.36 years,26.32±3.58,20.71±29.22 months and 16.57±2.98 months.No significant differences were noted in the gender,age,BMI,disease course,follow-up time,preoperative VAS and ODI between the PEID group and PETD group(P>0.05).The VAS scores of the PEID group and PETD group were(2.96±0.62,2.46±0.51,2.17±0.48,1.75±0.44,1.46±0.51;3.28±0.75,2.78±0.73,2.39±0.70,1.89±0.58,1.72±0.46)at 1 day after surgery,1 month after operation,3 months after surgery,6 months after operation,and 12 months after surgery,which were significantly lower than those preoperatively(7.63±0.97,7.50±0.92),with statistically significant differences(P<0.05).ODI indexes of the PEID group and PETD group of patients were(23.58±4.21,19.42±4.02,16.58±4.02;26.44±5.47,22.00±5.39,18.44±4.58)at 3 months after operation,6 months after operation and 12 months after surgery,which were significantly lower than those preoperatively(70.83±9.80,71.11±12.49),with statistically significant differences(P<0.05).No statistically significant differences were noted in the VAS scores(1 day,1 month,3 months,6 months and 12 months postoperatively),ODI index(3 months,6 months and 12 months postoperatively),intraoperative blood loss,postoperative hospital stay and complications between the PEID group and PETD group(P>0.05).The operation time and the number of intraoperative fluoroscopy times were significantly less in the PEID group than in the PETD group(P<0.05).According to the modified Mac Nab efficacy evaluation criteria at the last follow-up,in the PEID group,excellent: 13 cases,good: 9cases,fair: 2 cases,poor: 0 case,and the excellent and good rate of the PEID group was 91.67%;PETD group: 10 cases were excellent,6 cases were good,1 case was fair,1 case was bad,so the excellent and good rate of the PETD group was 88.89%.There was no significant difference in the excellent and good rate between the PEID and PETD group(P>0.05).Conclusions:1.Both PEID and PETD surgical methods can achieve good clinical effects in the treatment of CLDH and are good minimally invasive surgical techniques for the treatment of CLDH by using special tools such as ultrasonic osteotomes and variable directional grinding drills.2.The excellent and good rates of both PEID and PETD surgical modalities for L5-S1 CLDH was comparable.3.Compared with PETD,PEID has the advantages of shorter operation time,fewer fluoroscopy times,greater range of motion of working channel,more adequate resection of calcified intervertebral disc and decompression of nerve root in the treatment of CLDH.4.PEID was more suitable for patients with L5-S1 segment,obesity and high iliac crest CLDH.