A Comparative Study Of Percutaneous Endoscopic Lumbar Discectomy And Posterior Lumbar Fusion For Single-Segment Disc Herniation At L4-L5

Objective: The aim of this study was to investigate the differences between the two procedures and ultimately to compare the efficacy of percutaneous laminectomy(PELD)and posterior disc implant fusion(PLIF)in the treatment of single-segment lumbar disc herniation(LDH)at L4-L5.Methods: The clinical data of 117 patients who all had low back pain and/or lower limb pain and were diagnosed with L4-L5 single-segment LDH at the Department of Spine Surgery,The First Affiliated Hospital of Xinjiang Medical University from July 2019 to October 2021 were retrospectively analyzed,and the study population was divided into two groups,PELD and PLIF,according to the surgical procedure,with 68 patients in the PELD group and 49 patients in the PLIF group.The gender,age,body mass index(BMI),length of surgical incision,operative time,intraoperative bleeding,length of hospital stay,postoperative bed rest,complications and recurrence rate were recorded and compared between the two groups.Low back pain VAS and leg pain VAS were used to assess patients’ low back and lower limb pain before surgery,1 day after surgery and at the end,respectively.ODI impairment index,ODI improvement rate,JOA score,JOA improvement rate and modified Mac Nab criteria at the end follow-up were used to evaluate patients’ lumbar spine function.Results: The surgery was successfully completed in both the PELD and PLIF groups,and 117 patients(68 in the PELD group and 49 in the PLIF group)completed follow-up.All had good outcomes in the treatment of L4-L5 single-segment LDH.However,PELD had significant advantages over PLIF in terms of reducing incision length,shortening operation time,reducing blood loss,reducing postoperative bed rest and shortening the number of days in hospital.There were statistically significant differences between the two groups in terms of reducing VAS for low back pain,VAS for leg pain,reducing ODI scores and improving JOA scores compared with the preoperative period(P<0.05),but there was no statistically significant difference between the groups(P>0.05)There was no statistically significant difference between the two groups in terms of ODI improvement rate,JOA improvement rate,modified Mac Nab criteria at the last follow-up and other surgical efficacy.Conclusion: Both PELD and PLIF have good efficacy in the treatment of L4-L5 single-segment LDH,with no significant difference in long-term outcomes,but PELD shows its advantages in certain aspects,including the ability to complete surgical operations under local anaesthesia,small surgical incisions,short operative time,less intraoperative bleeding,faster relief of early low back and lower limb pain,shorter hospital stays and shorter postoperative bed rest,meeting the current short-term However,the PELD procedure has a certain degree of recurrence.However,PELD surgery has a certain recurrence rate that requires special attention,but PELD is still worthy of continuous development and promotion.