Comparison Of Interlaminar And Transforaminal Approach For Percutaneos Endoscopic Lumbar Discectomy

Background and Objectives: Lumbar disc herniation (LDH) is acommon diseases in the spinal surgery.It’s more common in adults and theelderly. The traditional surgical treatment has the disadvantages of severetrauma, postoperative scarring and long hospital stay. In recent years, withthe rapid development of minimally invasive spine surgery techniques,andpercutaneous endoscopic technology has improved steadily in thetreatment.The effect of surgery has also been widely recognized. In1983,Kambin proposed Kambin Triangle transforaminal approach. Clinicalapplication in recent years, percutaneous endoscopic lumbar discectomy(PELD) is more widely used, and has become one of the treatment of lumbardisc herniation surgery. It’s reported satisfaction rate is about90%, and nostatistical difference with open surgery. As the surgical operation under localanesthesia, surgery does not destroy the structure of lumbar spine boneligaments, no significant effect on the stability of the lumbar spine, and nosignificant stimulation of the nerves in the spinal canal and not causesignificant bleeding within the spinal canal, adhesions and scar formation.It has less trauma, less bleeding, shorter time in bed after surgery, the low costof surgery, fewer complications and quick recovery after surgery. But at theL5-S1section segment because of the iliac crest, lumbar transverse processand facet, percutaneous endoscopic approach has more choices in the L5-S1disc herniation treatment. It’s rarely reported about approach how tochoose.ZHANG were studied but how to choose is not clear enough.Therefore, it aims to compare percutaneous endoscopic about thecharacteristics in transforaminal approach and interlaminar, to explore theapproach selection in treatment of L5/S1lumbar disc herniation bypercutaneous endoscopy.Methods:68patients with L5-S1disc herniation admitted in August2011to August2012were divided into two groups by admission parity order,34patients in interlaminar approach group,34cases in transforaminalapproach group, comparing operative time, fluoroscopy times,patients’tolerance, therapy efficacy, postoperative residual symptoms, complicationsand preoperative and postoperative VAS pain scores.Results:4cases changed to transforaminal approach in interlaminargroup,7cases changed to interlaminar approach in transforaminal group,interlaminar group and transforaminal group operative time was50.2±7.0min,61.9±9.6min(p <0.05), fluoroscopy times of5.4±2.3,10.3±2.5(p<0.05), Leg pain preoperative VAS score of6.8±3.2, postoperative1.6±0.8, after surgery3months1.2±0.8in interlaminar group; Leg pain postoperative VAS score of7.8±2.2, postoperative1.2±0.6, after surgery3months1.0±0.5in transforaminal group, compared leg pain postoperativeand after surgery3months VAS score to preoperative were statisticallysignificant (P <0.05).The assessed was no significant difference (P>0.05) byModified MacNab standard.The total of excellent and good rate is88.2%.Conclusion: Lumbar disc herniation treated by percutaneousendoscopy has advantanges of faster recovery time, low cost of care, smallscars and worthy of recognition.And researchers believe that percutaneousendoscopic discectomy may become the gold standard in the future. But inL5-S1level, it’s more options to treatment and each of these option is worthyof recognition.As the interlaminar approach and transforaminal approach,the former aviod of the iliac crest, lumbar transverse and the the iliac-crestangle. At the same time, it’s shorter surgery time, fewer fluoroscopycomparig to the transforaminal approach.But it’s poor tolerance because ofeasier stimulating the nerve root. So they have different advantages anddisadvantages. We choose the interlaminar approach while the iliac crest ishigh and iliac-crest angle is big. If there is a narrow laminar space,we shouldchoose the transforaminal approach.Migrated herniation or herniation in theextreme outer side is not suitable for interlaminar approach.The clinicalphenotype of tension-type is more suitable for transforaminalapproach.Comprehensive assessment of the patient’s anatomy, imagepositioning and clinical phenotype is better to develop appropriate individualized surgical approach.