Patients′ intraoperative pain responses influence on the safety of percutaneous endoscopic lumbar surgery

Abstract

Objectives To evaluate the interaction between different anatomic sites, different contact methods and intraoperative pain in PELD, and analyze its value. Methods From Oct. 2015 to Feb. 2016, 74 patients with lumbar disc herniation and/or lumbar spinal stenosis, who were treated by using percutaneous endoscopic lumbar discectomy (PELD) in General Hospital of PLA and received complete intraoperative follow-up, were reviewed. There were 52 males and 22 females, ranging in age from 14 to 67 years, mean age was 40.14 years. The patients were operated by single levels, of which site in L4-5 was 40 cases and L5 to S1 was 34 cases. When surgeons contacted the tissues by endoscopic clamp and electrocoagulation normally, such as degenerate intervertebral disc, annulus fibrosus, the posterior longitudinal ligament and ligamentum flavum, patients′ visual analog score (VAS) were collected immediately. Factor A was anatomic site, factor B was contact methods. Analysis of variance was uesd to resolve the VAS of four different anatomic sites and two different contact methods. SNK q test was uesd to resolve multiple comparison in factor A and B. Results There were statistical significances separately in A and B (P< 0.05), but correlation between A and B was insignificant. Besides, multiple comparison in A was significant (P< 0.05). Different anatomic sites, contacted normally during PELD, reacted patients′ pain response. And the difference of pain response between different anatomic sites was significant. The pain response of the posterior longitudinal ligament was the most dramatic (VAS with endoscopic clamp was 7.05 ± 1.41, with electrocoagulation was 7.35 ± 1.53), annulus fibrosus was secondary (VAS with endoscopic clamp was 4.05 ± 1.43, with electrocoagulation was 5.35 ± 1.72), ligamentum flavum thirdly (VAS with endoscopic clamp was 3.76 ± 1.42, with electrocoagulation was 4.49 ± 1.59), degenerate intervertebral disc lastly (VAS with endoscopic clamp was 1.38 ± 1.40, with electrocoagulation was 2.08 ± 1.69). Different contact methods during PELD also reacted patients’ intraoperative pain response. The pain response of contact method by electrocoagulation was more severe than endoscopic clamp (VAS with electrocoagulation was more severe than endoscopic clamp in all anatomic sites). Correlation between different anatomic sites and different contact methods was insignificant. Conclusions We need to monitor patients’ pain responses immediately and effectively during PELD, it could help to avoid hurting tissue and raise the safety of operation. Key words: Percutaneous endoscopic lumbar discectomy; Intraoperative period; Pain