| Background:Low back pain is one of the leading reason for the patient to visit the hospital and consult a doctor as it affects the day to day activity of the people.Lumbar disc herniation is one of the most important causes which is associated with back pain.The patient affected by lumbar disc herniation not only present with low back pain but also may have other symptoms like leg pain which is typically worse than the back pain and if the pain radiates along the path of sciatic nerve it is termed as sciatica or radiculopathy,other symptoms like numbness,pin and needle feeling,weakness and tingling sensation in leg foot or toes depending upon the level of spinal nerve involved may be present.Sometimes the lumbar disc herniation may present with foot drop with patient feeling difficulty in lifting the foot and unable to walk properly,the patient may also present with an emergency condition like cauda equina syndrome for which emergency surgery is required.The disc herniation most commonly occurs at L5/S1 region and secondly at the level of L4/L5 but can occur anywhere in low back from L1 to S1 which presents as low back pain.The treatment option for LDH involves the conservative treatment and surgical treatment.The conservative treatment of LDH involves nonsteroidal anti-inflammatory drugs cause pain relief in patients with disc herniation.Objective:The purpose of this study was to select the symptomatic patient of lumbar disc herniation and to choose the patient who is suitable for surgery.With selection of the patient the study also aim to study the different surgical procedure that is in practice for the treatment of lumbar disc herniation and finally the main purpose of the study was to compare clinical outcomes of patient undergoing percutaneous endoscopic lumbar discectomy(PELD)and Posterior Lumbar Interbody Fusion(PLIF)for treatment of Lumbar disc herniation at the level of L4-L5 or L5-S1.Methods:In this retrospective case-control study,we went through and collected the medical records of 100 patients,all of whom had a chief complaint of low back pain with or without lower limb pain and were diagnosed with a Lumbar disc herniation at L4-5 or L5-S1 level.Firstly the patient was treated conservatively for 6 weeks and after the failure of conservative treatment all the patients underwent surgery,either PELD(50 patients)or PLIF(50 patients),at Department of Spine Surgery,the First Affiliated Hospital of Taishan Medical University(Taian,China)from January 2016 to December 2017,the total number of patients that were enrolled for the study were divided into two groups according to the surgical methods either Posterior lumbar interbody fusion or Percutaneous endoscopic lumbar discectomy being performed.Excluded from the study were patients with longterm Chronic Morbidity,calcified disc,severe neurological deficit,or instability in the joint.The straight leg raising test was performed in all patients.Clinical outcomes in the patients were assessed by using Visual Analogue Scale(VAS)score and Oswestry Disability Index(ODI).Radiological variables were assessed using plain radiography and/or magnetic resonance imaging.Pre and postoperatively.Results:The mean age of patients who were enrolled for the study was 40.49 years(range 20–50 years).The straight leg raising test was performed in all patients and was positive in 95 patients and negative in 5 patients.The neurologic deficit was present in 68 patients and absent in 32 patients.There were 42 patients with L4–L5 disc prolapse,58 of patients had L5-S1 disc prolapse.The mean operative time was 1 hour 12 minutes(range 40 mins – 3hrs)for PELD and the mean operative time was 2 hours 41 mins(range 2 hrs 10 mins– 4hrs 30 mins)for PLIF.The duration of surgery was longer in the initial cases and in patients who required bilateral approach.This is partly due to the learning curve.The mean hospitalization was 3.5 days(range 3 – 6 days)for PELD and 7.68 days(range 7 – 13 days)for PLIF.The mean follows up period was 16.8 months(range 12 months-2 years).Of the one hundred patients,the excellent outcome was noted in ninety patients,good outcome in six patients,fair result in two patients,and poor result in two patients.The mean VAS reduced from 7.2 ± 0.75 preoperatively to 5.2 ± 0.64 postoperatively(P < 0.001)in PLIF and it reduced drastically from 7.18 ± 0.74 preoperatively to 2.6 ± 0.53 postoperatively in PELD.ODI also showed marked improvement from a preoperative 67.6 ± 3.72 %_to a postoperative 13.18 ± 1.90 % in PLIF and 67.7 ± 4.04% preoperatively to 7.2 ± 1.14postoperatively`(P < 0.001)Conclusion:As a surgical treatment for lumbar disc herniation,both percutaneous endoscopic lumbar discectomy and Posterior lumbar interbody fusion showed favorable outcomes.But comparatively percutaneous endoscopic lumbar discectomy had advantages in terms of shorter operating time,blood loss and hospital stay over posterior lumbar interbody fusion. |
