Abstract
BackgroundDepending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique. Achieving good clinical therapeutic efficacy through the natural gap of bones can maximally avoid related access complications, and the necessary techniques and relevant anatomical factors were analyzed.MethodsBetween August 2012 and August 2014, 98 patients with L5 - S1 intervertebral disc herniation were treated with posterior percutaneous full-endoscopic discectomy (PPFED) by grafting tubes at various positions via the interlaminar approach. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to assess the patients’ back and leg pain and the improvements in daily function, and the modified Macnab standard was used to evaluate the treatment efficacy.ResultsAll 98 patients successfully completed the surgery, 84 patients got out of bed and walked on the first postoperative day, and 14 patients got out of bed and walked on the second postoperative day. The preoperative ODI (56.032 ± 3.625) was significantly higher than the ODI score (8.147 ± 1.398) (F = 5343.054, P ≤ 0.001) 48 months after surgery. The preoperative VAS score (7.193 ± 0.875) was significantly higher than the postoperative VAS score (0.914 ± 0.500 points) (F = 1656.173, P ≤ 0.001). The differences in ODI and VAS scores before and after surgery were statistically significant (P < 0.05). Follow-up was conducted 1, 6, 12 and 48 months postoperatively, and the modified Macnab standard was used during the last follow-up to evaluate the efficacy: 67 cases were excellent, 20 cases were good, 7 cases were fair, and 0 cases were poor; the proportion of excellent and good cases was 92.6%.ConclusionsThe treatment of L5 - S1 intervertebral disc herniation with PPFED by grafting tubes at various positions via an interlaminar approach is a safe, effective, and minimally invasive surgical method. Reaching the location of a disc herniation directly through the natural gap in the bones can maximally avoid collateral injury from spine surgery.Trial registrationThe registration number of this clinical study is ChiCTR1800014588; it has been retrospectively registered with a registration date of 05/01/2018.
Highlights
Depending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique
Traditional interlaminar fenestration and intervertebral disc removal together with interbody fusion still comprise a routine surgery for the treatment of lumbar disc herniation (LDH) [2]
To reduce surgical trauma and the occurrence of related iatrogenic complications and at the same time accurately remove the herniated disc tissue, minimally invasive techniques have gradually been developed in spinal surgery, including chemonucleolysis, percutaneous intervertebral disc resection, resection of the nucleus pulposus, minimally invasive intervertebral disc resection, percutaneous transforaminal endoscopic discectomy, and microscope-assisted discectomy [2,3,4]
Summary
Depending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique. To reduce surgical trauma and the occurrence of related iatrogenic complications and at the same time accurately remove the herniated disc tissue, minimally invasive techniques have gradually been developed in spinal surgery, including chemonucleolysis, percutaneous intervertebral disc resection, resection of the nucleus pulposus, minimally invasive intervertebral disc resection, percutaneous transforaminal endoscopic discectomy, and microscope-assisted discectomy [2,3,4]. With the rapid development and continuing improvement of endoscopic, optical, and channel technology, spinal endoscopy has become the prime surgical method for LDH treatment due to its clear field, minimal trauma, targeted resection of protruding lesions, capacity to prevent injuries to paraspinal muscles, lamina and other structures, and significant reduction of complications related to the early return of patients to society and work; at the same time, it achieves superior cosmetic effects compared with open surgery. The follow-up period was longer than four years, and satisfactory treatment results were achieved, as reported below
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
