Clinical Comparison Of Percutaneous Endoscopic Lumbar Discectomy And Microendoscopic In The Treatment Of Lumbar Spinal Stenosis

Objective With the speeding up pace of Chinese aging process,the patients having senile lumbocrural pain increased gradually.Lumbar spinal stenosis,a reason that cause the pain mentioned before,had atrracted more and more attention.Mimimally invasive surgical approach in lumbar tube stenosis was welcomeed by patients and doctors because of the less trauma and quick recovery.However, different types of surgical treatment are different, and the clinical effect is also different.The research is to retrospectively analyze the clinical efficacy of treatment of lumbar spinal canal stenosis through Percutaneous Endoscopic Lumbar Discectomy(PELD) and Microendoscopic Discectomy(MED), hoping that it could play a reference role when guding the clinical treatment in the lumbar spinal stenosisMethod A retrospective analysis of 64 cases of single lumbar tube stenosis patients(aged 36-74, average 59 years) treated by minimally invasive surgery from January 2014 to July 2015 in our hospital and all patients were followed-up 6-24 months(mean 17 months). The 64 patients were divided into two groups according to the operation method: PELD was 20 cases, including 14 males and 6 females, and MED 44 cases, with males 26 and females 18.Intraoperative X-ray number, operation time, intraoperative blood loss, postoperative bed time and postoperative hospital stay were compared between the groups.To record preoperative visual analog score(VAS), postoperative VAS score of operating day, postoperative VAS score after 3 days, postoperative VAS score after a week, postoperative VAS score after 3 months,postoperative VAS score after half a year and postoperative VAS score of the last follow-up, to analysis the VAS score changes and to evaluate low back pain remission.To record postoperative oswestry disability index(ODI)score, postoperative ODI score after three months,postoperative ODI score after six months and postoperative ODI score of the last follow-up, to analysis the ODI score changes and to evaluate lumbar function.Result The times of intraoperative X-ray of PELD was more than that of MED group, with the operation time of PELD group longer than that of MED group, and the difference was statistically significant(P < 0.05); The amount of bleeding, postoperative bed time and postoperative hospital stay were lower in PELD group compared with MED(P < 0.05). The VAS core and ODI score was significantly changed in a better way in the two groups(P < 0.05),and preoperative VAS score, postoperative VAS score of operating day and postoperative VAS score after 3 days of PELD declined more than that of MED,and there was a significant difference in the two groups(P < 0.05) postoperative VAS score after a week, postoperative VAS score after 3 months,postoperative VAS score after half a year and postoperative VAS score of the last follow-up were declined in both PLED and MED group and there was no significant difference between them(P > 0.05).Postoperative ODI score, postoperative ODI scoreafter three months,postoperative ODI score after six months and postoperative ODI score of the last follow-up changed in both group,and there was no significant difference between the two groups. Patients in PELD group did not use the analgesic drugs during hospitalization except 2 patients taking Etoricoxib Tablets0.12 g once just the night after the operating, and all using the analgesic drugs during hospitalization in Med group.On cases of postoperative recurred after 1 mouths in PELD,the conservative treatment for 6 weeks after the effect is poor, and fusion surgery was underwent. 1 cases of discogenic low back pain recurred after surgery in PELD,and fusion surgery was underwent after 3mouths of effectless conservative treatment.and the follow-up of the two cases was terminated at before the secondary surgery.In PELD group,there was one patient concurred lower limb numbness after surgery, considering the posibility of nerve root traction,and the patient recovered well after a conservative treatment.One patient got remission of symptoms in lower limb after surgery, with an over-three-month conservative treatment turning out ineffective, a MED surgery was carried out,the Clinical symptoms disappeared, and a 9 months follow-up showed no recurrence.In MED group one patients got dural rupture during the surgery,Gelatin sponge was used to press the rupture to stop the cerebrospinal fluid leakage given to the small size of the rupture.The patient was given a cerebrospinal-fluid-leakage treatment after the surgery, and recovered well.One patient was found a Lumbosacral nerve root anomalies, with two nerve root coming out through the same nerve root foramen,thus a careful operation is needed,in addition to remove part of lamina and to remove partof Lumbar facet to expanse the intervertebral foramen facet row, the Clinical symptoms disappeared,and a follow-up showed good recovery.One patient without any low back pain relief after the surgery,an half a year conservative treatment showed poor efficacy,and a fusion surgery is operated,and a follow-up showed good recovery.Conclusion In the case of adequate decompression,PELD had the advantage of less trama,a faster pain relief than MED,proving that PELD was a better way in treatment of patients with lumbar spinal stenosis. However, due to the limitations of PELD decompression, which can only be used as a supplementary treatment of MED LSS, the two groups can be combined as the LSS ladder treatment.