Comparision Of Preliminary Surgical Outcomes Between Percutaneous Transforaminal Endoscopic Discectomy And Microsurgical Lumbar Discectomy For Lumbar Disc Herniation

Objective：（1） To investigate the preliminary efficacy of the percutaneous transforaminalendoscopic discectomy（PTED）and microsurgical lumbar discectomy（MSLD）forsingle segment lumbar disc herniation（LDH）．（2） To evaluate the different influence of the two kinds of operation on lumbarspinal stability.Method：106cases with single segment LDH were included in this retrospective studyfrom October2010to March2012. All the patients were divided into2groups byreceiving different kinds of operation: PTED in48cases and MSLD in58cases. Themean course of patients in PTED and MSLD group were14months (range,5months-6years) and20months (range,6days-7years) respectively. The relatedfactors of the operations such as the length of skin incision, operation time and so onwere included in the study. The clinical outcomes were evaluated by visual analoguescale(VAS)，Japanese Orthopaedic Association(JOA) Scores,0swestry disabilityindex(ODI) and modified MacNab criteria. After six months of the operation, thelumbar curves (Cobb’s Angle) and disc height were employed to evaluate the patients’lumbar spinal stability.Result：After operation the data showed that there were significant differences in all theobservation factors(P<0.01) except for the operation time and the rate of returning to work(P>0.05) between the2groups. And the incidence of the complications in PTEDgroup(8.3%) were lower than that of in MSLD group(17.2%). The mean follow-upwas16.7months in PTED group and17.3months in MSLD group respectively.According to the Visual Analogue scale(VAS)，Japanese Orthopaedic AssociationScores，0swestry disability index(0DI) and modified MacNab criteria，there weresignificant differences in intra-group comparison with pre-operation (P<0.05), and theVAS of lumbar showed that the effect of PTED was better than MSLD in3month ofpost-operation. In the6months’ follow up, the influence of MSLD on the lumbarinstability was more obvious than that of PTED.Conclusion：(1) PTED and MSLD were both reliable operation for the single segment LDH andthere was no significant difference in preliminary clinical outcome between the2groups.(2) Compared to MSLD, PTED maybe a more perfect surgical approach with theadvantages of minimal invasion, early recovery and little influence on the lumbarstability.