Clinical Analysis Of PETD Versus PLIF For Lumbar Disc Herniation Caused By Gluteal Pain

Background:Lumbar disc herniation(LDH)is a degenerative disease of the spine.80% of patients suffer from pain associated with LDH that interferes with their lives and work,with low back pain being the most common,accompanied by sciatica in about5% of men and 2.5% of women.Gluteal pain is also a complaint,sometimes the only complaint in some patients with LDH.Purpose:This study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy(PETD)in the surgical management of single-segment lumbar disc herniation(LDH)gluteal pain and to determine whether it provides a better clinical outcome than Posterior lumbar interbody fusion(PLIF).Methods:A retrospective analysis of patients treated with modified PETD and PLIF for gluteal pain in LDH from January 2015 to December 2020 was conducted.Demographic information,primary clinical evaluation indicators,and secondary clinical evaluation indicators were recorded and analyzed.The primary clinical evaluation indicators were assessed by the visual analogue scale(VAS),Oswestry Disability Index(ODI),Japanese Orthopaedic Association score(JOA),and modified Mac Nab criteria.The preoperative and postoperative VAS,ODI and JOA scores were recorded by two assistants.When the results were inconsistent,the assessment was recorded again by the professor,and the data with the smaller difference in scores were selected for recording.Secondary clinical evaluation indicators included procedure time(minutes),intraoperative blood loss(ml),hospital days,costs(RMB),fluoroscopy shots,recurrence rate and complications rate,etc.Statistical analysis of the results was performed,and magnetic resonance imaging(MRI)was used to assess radiological improvements,and all patients were followed for at least one year.Results:A total of 93 patients were included,47 of whom underwent modified PETD,and 46 of whom underwent PLIF.In the modified PETD intragroup comparison,VAS scores ranged from 7.14±0.89 preoperatively to 2.00±0.58,2.68±0.70,2.55±0.69,2.23±0.81,and 1.85±0.72 at 7 days,1 month,3 months,6 months,and 12 months postoperatively.Patients showed significant pain relief postoperatively(P <0.01).According to the modified Mac Nab score,the excellent rate in the PETD group was89.36%.There was no significant difference compared to the PLIF group(89.13%,P >0.05).Complication rates were lower(P >0.05)but recurrence rates were higher(P >0.05)in the modified PETD group than in the PLIF group.The modified PETD group had a faster operative time(P <0.01),shorter hospital stays(P <0.01),less intraoperative bleeding(P <0.01),and less financial burden to the patient(P <0.01)than the PLIF group.At 7 days postoperatively,the VAS score for low back pain was higher in the PLIF group than in the modified PETD group(P <0.01).The VAS and JOA scores at 1,3,6,and 12 months postoperatively were not significantly different between the modified PETD and PLIF groups(P >0.05),and the ODI was significantly different at 3 months postoperatively(P <0.05).Conclusion:1.PETD and PLIF can effectively treat gluteal pain caused by LDH.2.PETD is safe and effective in the treatment of gluteal pain caused by L4/5 disc herniation,and has the advantages of low complication rate,rapid postoperative recovery,short hospital stay,low anesthesia risk,and low surgical cost compared with PLIF.3.PETD has a certain recurrence rate,and secondary surgery due to recurrence may increase the financial burden.