Clinical Efficacy And Imaging Analysis Of L4/5 Discectomy With Endoscopic Transforaminal Approach And Interlaminar Approach

Objective: To compare the clinical efficacy of endoscopic transforaminal lumbar discectomy and interlaminar lumbar discectomy in the treatment of paracentral L4/5 disc herniation,and to analyze the differences in the impact on the bony structure of lumbar articular process after surgery.Methods: The clinical data of 80 patients with paracentric L4/5 lumbar disc herniation treated in the Department of Spinal surgery of the affiliated Hospital of Qingdao University from June 2020 to January 2022 were collected and divided into two groups according to different surgical approaches: transforaminal approach(PETD)in 40 cases and interlaminar approach(PEID)in 40 cases.The general data(sex,age,course of disease)of the two groups were recorded.The frequency of fluoroscopy during operation,the days of hospitalization,the visual analogue score of low back pain(visualanaloguescale,VAS)before and 3 days,3 months and 6 months after operation,and the lumbar Oswestry dysfunction index(Oswestrydisabilityindex,ODI)3 days,3 months and 6 months before and after operation.The clinical effect was evaluated by modified MacNab standard.The three-dimensional CT images were measured before and after operation by the three-dimensional medical image segmentation software ITK-SNAP,and the removal volume of joint process was calculated.The projection area of articular process before and after three-dimensional CT was measured by CEWorkstation software,the projection area of articular process resected was calculated,and the relative ratio of articular process cutting surface was obtained(the projection area of resected articular process accounted for the whole articular process).The resection volume and relative value of the two methods were compared,and the interference of the two methods on the stability of facet joint was compared.Results: There was no significant difference in general data between the two groups(P>0.05).The operation time of PEID group was 74.36±2.83 min,and the number of intraoperative fluoroscopy was 5.03±0.22 times.The operation time of PETD group was91.18±2.25 min,and the number of intraoperative fluoroscopy was 14.45±0.47 times.The operation time and intraoperative fluoroscopy times of PEID group were significantly less than those of PETD group,and the differences were statistically significant(P<0.05).The length of hospital stay for PEID was 3.93±0.30 days,and the length of hospital stay for PETD was 3.93±0.18 days.There was no significant difference in the length of hospital stay between the two groups(P>0.05).The VAS scores of low back pain in the PEID group before operation,3 days,3 months and 6 months after operation were: 4.95±0.16,2.35±0.16,1.28±0.14,0.83±0.15.The VAS scores of leg pain before operation,3 days,3 months,and 6months after operation in PEID group were: 6.80±0.18,3.05±0.21,1.75±0.80,0.88±0.16.VAS scores of low back pain before operation,3 days,3 months,and 6 months after operation in PETD group were: 5.30±0.19,2.58±0.18,1.30±0.17,0.73±0.14.The VAS scores of leg pain before operation,3 days,3 months,and 6 months after operation in PETD group were: 6.95±0.18,3.15±0.17,1.70±0.16,1.00±0.18,postoperative VAS scores of low back and leg pain in the two groups were significantly lower than those before operation(P<0.05),but there was no significant difference in VAS scores between the two groups at the same time point(P>0.05).The ODI scores of PEID group before operation,3 days after operation,3 months after operation,and 6 months after operation were 57.90±0.90,25.75±2.72,22.66±0.60,and 11.90±0.48,respectively.The ODI scores of PETD group before operation,3 days,3 months,and 6 months after operation were: 55.13±0.77,25.14±2.83,22.45±0.40,12.78±0.39,the postoperative ODI of the two groups was significantly lower than that before operation(P<0.05),but there was no statistically significant difference between the two groups at the same time point(P>0.05).At 6 months after operation,the modified MacNab criterion was used to evaluate the efficacy of the two groups: in PTID group,30 cases were excellent,7 cases were good,2 cases were medium,1case was poor,and the excellent and good rate was 92.5%.In PETD group,29 cases were excellent,7 cases were good,3 cases were medium,1 case was poor,and the excellent and good rate was 90%.There was no significant difference in the excellent and good rate between the two groups(P>0.05).The bone volume of postoperative facet resection in PEID group was 312.85±6.26mm~3,and that in PETD group was 750.15±13.86mm~3.The bone volume of postoperative facet resection in PEID group was significantly less than that in PETD group,and the difference was statistically significant(P<0.05).0.28±0.01 and0.46±0.02 in PETD group,PEID group was smaller than PETD group,and the comparison was statistically significant(P<0.05).Conclusion: Spinal endoscopic transforaminal approach and interlaminar approach are similar in the treatment of paracentric L4scar5 disc herniation,both of which can relieve low back pain and improve lumbar function,and the curative effect is satisfactory.interlaminar approach has a short operation time,less fluoroscopy,less facet resection,and has little effect on the stability of facet joint.