| Background: Some patients with lumbar disc herniation(LDH)suffer from both pain and later shift or trunk list.In addition to pain,patients have concerns regarding whether trunk list is reversible.Surgical treatment is performed when pain is intractable to conservative management,and the trunk list will be relieved effectively.Percutaneous Endoscopic Lumbar Discectomy(PELD)is one of the surgical treatment options for LDH,but few results concerning its effect on trunk list have been reported.Objectives: The objectives of the present study were to determine the relationship between the LDH and the sciatic scoliosis,and the outcomes of Sciatic Scoliosis by Lumbar Disc Herniation(SSLDH)after PELD.Methods: In this retrospective observational study,we selected 47 patients diagnosed with SSLDH from January 2016 to August 2016.There are 23 males and 14 females,and the average age of the patients is 33.4(11-57 years old).All the patients suffered from both unilateral pain and trunk list after over 1 month conservative management,and received none surgical treatment before.There are 29 patients with innervation area numbness and 9 patients with strength weakness.All the patients underwent the treatment of PLED.We measured the pain in low back and legs by Visual Analogue Scale(VAS)before surgery and 3,6months and the last follow-up.The Oswestry disability index(ODI)and Japanese Orthopaedic Association Scores(JOA)were measured the low back disability in patients and the Cobb's angle between L1 and S1 on spine radiographs taken before surgery and the last follow-up to define the change of the trunk list.The outcome was graded using the Mac Nab criteria.Results: All the 47 patients were follow-up,and the average time is 11months(between 6 to 14 months).One of the patients receive reoperation because of no improve of weakness,two patients involved reherniation in adjacent segment and others significantly improved in clinical symptoms.The mean VAS score of low back pain reduced from(5.91±1.36)preoperatively to(3.93±0.84),(2.72±1.14),(2.11±1.31)at 3 months,6months and the last follow-up respectively,and the score of leg pain is from(7.70±0.98)to(2.23±1.22),(1.81±1.33)and(1.38±1.47)respectively.The ODI score is(68.51±11.75)before operation and significantly reduced to(11.82±10.12)at follow-up(Z=-6.71,P<0.001),while the JOA score significantly improved from(8.72±1.64)preoperatively to(24.47±3.01)at the last follow-up(t=-37.22,P<0.001),and the clinical improvement rate is(77.87±14.10)%.The mean Cobb's angle is(12.98±5.92)°preoperatively and improved to(3.81±3.22)°(Z=-5.72,P<0.001).Among the patients,10 people corrected completely,23 improved obviously,13 improved and 1 had on change in the Cobb's angle.The outcomes were excellent in 30 patients,good in 11 patients,fair in 6 patients and poor in 1 by Macnab criteria.Conclusions: PELD can relieve the symptoms and correct the scoliosis through a minimally invasive approach,which has the advantage of small trauma,less bleeding and faster recovery.It can provide a great outcome for the most of the patients with SSLDH.There are some relationship in the direction of scoliosis,the location of lumbar disc herniation and the side of symptomatic in the patient with SSLDH.35 of 47 patients(74.4%)had a trunk list away from the side symptoms,33 of 47patients(70.2%)had a lumbar disc herniation at the convex side of scoliosis. |
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