Percutaneous Endoscopic Lumbar Diskectomy for Axillar Herniation at L5-S1 via the Transforaminal Approach Versus the Interlaminar Approach: A Prospective Clinical Trial

Abstract

To evaluate the results of percutaneous endoscopic transforaminal diskectomy (PETD) in comparison with percutaneous endoscopic interlaminar diskectomy (PEID) for axillar herniation at L5-S1. From January 2017 to March 2018, 80 patients admitted with axillar herniation at L5-S1 were randomly recruited into 2 groups: 40 cases in the PETD group and 40 in the PEID group. Each group separately underwent PETD or PEID. Patient sex, age, body mass index, axillar herniation size, number of C-arm fluoroscopies, operation time, postoperative bed time, complications, and clinical effect were compared. Both groups were followed-up using the Oswestry Disability Index (ODI), visual analog scale (VAS), and Macnab criteria. Except for 1 case in the PETD group that switched to the PEID group, the patients completed the study as expected. All patients were followed-up. Preoperative demographics were not significantly different (P > 0.05) between the 2 groups. The mean number of C-arm fluoroscopies (12.44 ± 3.21) and the operation time (66.49±16.29 minutes) of the PETD group were significantly improved compared with the PEID group (number of fluoroscopies: 3.41 ± 0.81, P < 0.001; operation time: 53.56±10.82 minutes, P < 0.001), but the postoperative bed rest time and complication rate were not (P > 0.05). The postoperative ODI and VAS scores were obviously improved in both groups when compared with preoperation (P < 0.001). There were no significant differences between the 2 groups in the Macnab criteria or VAS and ODI scores at the same time point (P > 0.05). For axillar herniation at L5-S1, PEID can ignore the anatomic obstruction with advantages including a shorter operation time and less intraoperative radiation exposure. PETD has a clinical effect similar to that of PEID, but the process of it is more dangerous and harder than PEID.