Comparison of results between fenestration discectomy associated with annulus repair and fenestration discectomy for lumbar disc herniation in the adolescents

Abstract

To compare the preliminary clinical outcomes of fenestration discectomy associated with annulus repair (FDAR) and fenestration discectomy (FD) for lumbar disc herniation in the adolescents. The data of 26 adolescent patients with single segment lumbar disc herniation who were admitted to the Department of Orthopedics, Xuzhou Central Hospital from October 2012 to October 2014 were retrospectively studied. All patients were divided into 2 groups, including 12 patients undergoing FDAR and 14 patients undergoing FD respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The indentation of dura were measured from MRI. Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later. The visual analogue scale (VAS), the oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes. Simultaneously, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. There were no significant differences in the observational factors such as the skin incision length, amount of intraoperative bleeding, operation time, and duration of hospitalization between the FDAR and FD groups (P>0.05). The indentation of the dura significantly reduced after surgery in each group [FDAR: (7.3±2.6) vs (1.3±0.8) mm; FD: (7.4±3.1) vs (2.9±0.7) mm; both P<0.05]. The postoperative lumbar disc degeneration in FDAR group was the same as that of in FD group. The postoperative VAS scores and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P<0.05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate (FDAR: 88.5%, FD: 87.2%; P>0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (FDAR: 89.3%, FD: 88.5%; P>0.05). There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications in both groups. But there was one patient regaining the back and leg pain in the FD group, whereas recovering by conservative treatment. The preliminary clinical efficacy of both FDAR and FD in the treatment of single segment lumbar disc herniation in the adolescents is satisfactory.