Abstract
Objective The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P < 0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.
Highlights
Lumbar disc herniations (LDH) are one of the most common causes of lower back pain and sciatica. 70%–85% of people suffered at least one episode of lower back pain with or without leg pain during their lives [1, 2, 3]
There are many advantages of using the percutaneous endoscopic lumbar discectomy (PELD) technique, such as shorter operating time, less blood loss and postoperative pain, and faster postoperative rehabilitation and preservation of normal paraspinal structures, which contribute to a lower incidence of iatrogenic instability [7, 8, 9, 10]. erefore, PELD has been regarded as an alternative to conventional open surgery for lumbar disc herniations [6, 11, 12]
We found that the outcomes of five patients were excellent, eight patients were good, and one patient was fair in the two-level PELD group, while the outcomes of 11 patients were excellent, 13 patients were good, one patient was fair, and one patient was poor in the foraminoplasty group (Table 2). ere were no significant differences in the satisfaction rates between these two surgical procedures (92.9% versus 92.3%, P 0.92)
Summary
Lumbar disc herniations (LDH) are one of the most common causes of lower back pain and sciatica. 70%–85% of people suffered at least one episode of lower back pain with or without leg pain during their lives [1, 2, 3]. It has been proved that the technique of PELD can effectively remove the herniated nucleus pulposus, can release nerve roots through the intervertebral foramen, and can achieve comparative clinical outcomes as the conventional open surgery [3, 6]. With the development of techniques and instruments, such as wide application of reamer kits, high-speed endoscopic drills, and flexible curved forceps in clinical practice, the indications of PELD have been extended to highly migrated disc herniations [15, 16, 17, 18, 19, 20]. We have developed a new PELD technique for the treatment of highly migrated disc herniations via a novel two-level approach [19]. We set up a comparative study using a cohort of patients who had highly migrated lumbar disc herniations undergoing foraminoplasty PELD or two-level PELD. We set up a comparative study using a cohort of patients who had highly migrated lumbar disc herniations undergoing foraminoplasty PELD or two-level PELD. e objective of this study was to systematically compare the clinical outcomes and postoperative complications of these two techniques
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