Abstract
Objective:To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH.Methods:From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach.Results:All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient’s leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred.Conclusion:When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement.
Highlights
The clinical incidence of disc herniation is high.[1]
Pak J Med Sci September 2021 (Speical Issue Online) Vol 37 No 6 www.pjms.org.pk 1667 approach PELD has been used in the treatment of various types of lumbar disc herniation (LDH) with good clinical efficacy.[3,4]
The preoperative MRI sagittal T2WI showed that the nucleus pulposus prolapse of L5/S1 disc moved upward and exceeded L5. /S1 intervertebral space height, nucleus pulposus signal decreased; B. preoperative MRI cross-sectional T2WI showed prolapsed nucleus pulposus tissue compression of the right nerve root and Dural sac; C. preoperative CT showed LDH, no obvious calcification; D
Summary
The clinical incidence of disc herniation is high.[1] Endoscopic extraction of spinal nucleus pulposus is a more widely used minimally invasive operation modality in clinical application. It has the advantages of little intraoperative blood loss, small trauma area, quick postoperative recovery of patients, and obvious therapeutic effect.[2] With the development of minimally invasive techniques, percutaneous endoscopic lumbar nucleus pulposus excision (PELD) has become more and more mature. Pak J Med Sci September 2021 (Speical Issue Online) Vol 37 No 6 www.pjms.org.pk 1667 approach PELD has been used in the treatment of various types of lumbar disc herniation (LDH) with good clinical efficacy.[3,4] Studies indicated that the therapeutic effect of endoscopic spinal nucleus pulposus extraction was similar to that of traditional open discectomy.[5,6,7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
