| Background and Objectives: Lumbar disc herniation is a common disease in spinal surgery. The traditional open surgery has the disadvantages of severe trauma and spinal instability post-operation. With the developments of modern minimally surgical instruments and fiber endoscope, transforaminal percutaneous endoscopic discectomy applis to clinical. transforaminal percutaneous endoscopic discectomy has the advantages of invasive, relative safety, recovering quickly, and can effectively maintain spinal stability, etc. transforaminal percutaneous endoscopic discectomy can be operated under local anesthesia, some surgeons insist that it should be performed by prone, while the others insist the side-lying position. Currently, there are no comparisons among these different positions, so we compared the differences between side-lying position and prone position, to observe the curative effect of treating lumbar intervertebral disc herniation, to investigate the influences for the surgeons and compliance and comfort of the patients during these different positions.Methods: From Feb 2009 to Feb 2010, we selected 48 patients with lumbar disc herniation to treat, they had no lumbar spondylolisthesis and lumbar instability. According to the herniated segment , these patients were randomly divided into two groups (group A and group B)。Group A including L3 / 4 3 cases. L4 / 5 12 cases, L 5/S1 9 cases, Group B including L3 / 4 2 cases. L4 / 5 12 cases, L 5/S1 10 cases. 24 cases in each group. All cases in group A and group B underwent transforaminal percutaneous endoscopic discectomy in lateral and prone position respectively . Both group has 5 cases of L 5/S1 with posterior interlaminar approach taken, and the remaining patients were taken by posterolateral foraminal approach. They were followed up for 2 months, recording the operation time, intraoperative feeling ,the visual analog score (VAS) and Oswestry functional disability index (ODI) evaluation. At the same time, the patients` satisfaction of curative effect and Acceptance rate of reoperation were also investigated, then, the above datas were analyzed by statistical analysis.Results: two cases of L3 / 4 disc herniation patients of group A can not tolerate the prone position before surgery, so joined the group B. Operations were successfully completed. No serious complications were happened. Operation time of group A was 92.5±32.5min, while that of group B was 95.0±34.0 min; The VAS score preoperative of group A was 6.0±3.2, that of group B was 6.4±3.0; The VAS score of two months after the surgery of group A was 1.2±1.0, and that of group B was 1.2±1.1; The ODI preoperative of group A is 30.0±9.5, that of group B is31.0±9.0; The ODI of two months after the surgery of group A was 11.0±6.5 ,that of group B is 12.0±5.0;The patients who underwent transforaminal percutaneous endoscopic discectomy in two different positions, the VAS pain score and the ODI score obviously alleviated in two months after the surgery, but the clinical effect had no significant differences. During the surgery, the extremely uncomfortable situation and acceptance rate of reoperation of the lateral position were obviously less than the prone position.Conclusions: Transforaminal percutaneous endoscopic discectomy in two positions is the effective and minimally invasive method in the treatment of lumbar disc heniation. Lateral position is more secure for surgical anesthesia intravenous drug use. To the L3 / 4 disc herniation surgery in patients, lateral position should be adopted. Through the laminar space to underlay the approach in the lateral position, the use of pillow could benefit patients of opening foramen, dural sac to the contralateral side, making the surgeries safer. For patients with neck pain, the discomfort happened less in this position. Surgical procedures can only operate on patients on unilateral side under the lateral position, can not operate on both sides, and the patient position was not fixed in lateral position, more X ray examination were increased, operative time was relatively prolonged.
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