The Comparison Of Percutaneous Endoscopic Lumbar Discectomy For Lumbar Disc Herniation And Lumbar Stenosis In Elder Patients

Objective:To assess the efficiency and safety of Percutaneous Endoscopic Lumbar Discectomy (PELD) decompression between lumbar disc herniation (LDH) and lumbar spine stenosis (LSS) for elder patients.Methods:From June 2014,30 consecutive elder patients with lumbar disc herniation and 30 consecutive elder patients with lumbar stenosis were decompressed using Percutaneous Endoscopic Lumbar Discectomy. Following up all patients at 3 month and 1 year after surgery. Outcome measures consisted of operation time, visual analog scale(VAS) and Oswestry disability index(ODI) between preoperative and postoperative, and modified MacNab criteria were compared. The alleviation of VAS and ODI (alleviation= preoperative score-postoperative score) is also been analyzed. Patients with lumbar spinal stenosis are divided into different subgroups according to the image, and analyze the operation time, the VAS and ODI scores preoperative,3 months postoperative, and 1 year postoperative respectively in each subgroup and analyze VAS and ODI improvement between subgroups. The modified MacNab criteria is used to evaluate the result at the time of 1year follow-up.Resules:(1) Analysis in each group:Between LDH and LSS group, the analysis of VAS and ODI scores between preoperative and postoperative both show a greatly decrease after surgery(P<0.05). (2) Analysis between groups:The average operation time of LDH is 52.32±14.17min, while LSS is 72.14±12.10min. Differences between two groups have statistical significance (P<0.05). After 3 months of operation, patients with lumbar disc herniation have a better recovery than with lumbar stenosis, since the alleviation of VAS and ODI is different from LSS in statistics (P<0.05).But after 1 year of operation, there were no difference between two groups (P>0.05). Based on the modified MacNab criteria, at 1 year follow-up, excellent and good rates of two groups were 86.7% and 76.7%. One patient in LSS group turned to opening surgery. (3) Subgroup analysis in LSS:The average operation time of central LSS is 76.13±9.27min, while in lateral recess and intervertebral foramen LSS is 69.31±13.24min. Differences between two groups have statistical significance (P<0.05). After 3 months of operation, patients with lateral recess and intervertebral foramen LSS have a better recovery than with central LSS, since the alleviation of VAS and ODI is different from LSS in statistics (P<0.05). After 1 year of operation, the alleviation of VAS between two groups has no difference (P>0.05), but the lateral recess and intervertebral foramen LSS group has a better recover in ODI than the central LSS group(P<0.05). Based on the modified MacNab criteria, at 1 year follow-up, excellent and good rates in lateral recess and intervertebral foramen LSS group is 80.9%, while central LSS group is 76.7%. One patient in central LSS group turned to opening surgery.Conclusion:(1)With a 3 months follow-up, Percutaneous Endoscopic Lumbar Discectomy (PELD) has a better result for lumbar disc herniation than lumbar stenosis in elder patients, but no difference was found in a 1 year follow-up. (2) With a 3 months follow-up, PELD has a better result for lateral recess and intervertebral foramen LSS than central LSS in elder patients. After 1 year, patients with lateral recess and intervertebral foramen limber spine stenosis may recover better. (3) So, with exact indications, Percutaneous Endoscopic Lumbar Discectomy (PELD) is a safe and effective technique for lumbar disc herniation and lumbar stenosis in elder patients. But for central lumbar spine stenosis, especially in multiple level patient, it still need more study.