Clinical effects of three minimally invasive surgery for L5/S1 lumbar disc herniation

Abstract

Objective To compare the clinical effects of three different minimally invasive surgery for L5/S1 lumbar disc herniation. Methods Two hundred and twenty-seven patients suffering from lumbar disc herniation with microsurgical lumbar discectomy (MSLD), percutaneous endoscopic transforaminal discectomy (PETD) or percutaneous endoscopic interlaminar discectomy (PEID) from May 2013 to May 2016 were retrospectively reviewed and analyzed. There were 85 patients in MSLD group, 65 patients in PETD group and 77 patients in PEID group. Surgical time, bleeding, perioperative complication, bedridden time, hospitalization, recurrence, creatine kinase, visual analogue scale (VAS), Oswestry disability index (ODI), and SF-36 were recorded. Results All the patients underwent surgery successfully. PETD and PEID were significantly better than MSLD (all P values 0.05). Preoperative and postoperative 1 month, 6 months and 12 months, the ODI for patients in MSLD group were 33.6%±7.9%, 11.3%±2.6%, 7.0%±2.5% and 4.8%±2.4%, the ODI score for patients in PETD group were 32.3%±8.6%, 10.8%±3.6%, 6.6%±2.6% and 4.7%±3.5%, the ODI for patients in PEID group were 32.6%±9.7%, 10.6%±2.7%, 6.2%±1.9% and 4.7%±2.8%, and no significant differences were found in three groups at different time points (all P values>0.05). Preoperative and postoperative 1 month, 6 months and 12 months, the SF-36 score for patients in MSLD group were 47.6±19.5, 50.2±19.8, 51.3±20.2 and 54.3±19.4, the SF-36 score for patients in PETD group were 48.4±20.0, 51.3±20.2, 51.3±21.9 and 53.4±18.6, the SF-36 score for patients in PEID group were 47.4±18.24, 52.4±22.91, 52.2±19.9 and 54.0±20.9, and no significant differences were found in three groups at different time points (all P values>0.05). Preoperative and postoperative 12 hours, 24 hours and 48 hours, the creatine kinase for patients were (65.76±6.48)μ/L, ( 98.79±12.08)μ/L, (119.34±16.27)μ/L and (139.23±14.23) u/L in MSLD group, were 65.98±7.48, 97.56±11.07, 117.32±10.34 and 137.48±13.89 in PETD group, were 66.47±8.76, 97.78±10.45, 116.25±9.89 and 138.36±16.27 in PEID group, and no significant differences were found in three groups at different time points (all P values>0.05). There were 2 recurrent cases in MSLD group, 6 in PETD group, and 8 in PEID group. Significant differences were found between the three groups for recurrence rates (χ2=5.051, P 0.05) at the last follow up. Conclusions For L5/S1 lumbar disc herniation, clinical effects of all the three minimally invasive surgery in this research are satisfactory. Each surgery has its own advantages, disadvantages and indications. Therefore, surgeons should choose the optimal treatment base on patient's situation to achieve the best therapeutic effect. Key words: Intervertebral disc displacement; Lumbar; Microsurgery; Minimally invasive; Percutaneous endoscopic