Analysis Of Clinical Effects Of Percutaneous Endoscopic L5/S1 Lumbar Discectomy Through Transforaminal Approach And Interlaminar Approach

Objective:To Compare the difference and Clinical effects of percutaneous endoscopic L5/S1 lumbar discectomy through transforaminal approach and interlaminar approach.Methods:From June 2015 to March 2017,93 cases of L5/S1 lumbar disc herniation who underwent percutaneous endoscopic lumbar discectomy in this retrospective study.All patients were divided to PETD(62cases)group and PEID(31cases)group according to the difference of surgical approaches.The sex,age,herniation type,operation time,the bleeding,surgical costs,postoperative hospital stay and hospital stay were all recorded.Postoperative effectiveness was assessed based on the lumbar and leg JOA scroe,VAS score,ODI score and the 1st year after operation modified MacNab criteria.Result:Both groups completed surgery,the operation time was(88.29±11.99)minutes,The bleeding was(17.73±6.63)milliliter,surgical costs was(18675.55±3182.67)yuan,postope-rative hospital days were(3.79±1.87)days and hospital stay were(8.15±3.65)in PETD group.In PETD group,the operation time was(74.84±7.80)minutes,the bleeding was(18.55±5.03)milliliter,Surgical costs was(25346.33± 4407.84)yuan,postoperative hospital stay were(4.42±2.20)days and Hospital stay were(9.00±3.90).PEID group had less operation time than PETD group(P<0.05),PETD group had less surgical costs than PEID group(P<0.05).There was no difference in sex,age,herniation type,the bleeding,postoperative hospital stay and hospital stay between 2 groups(P>0.05).In PETD group,3 patients were complicated with postoperative dysesthesia,3 patients eased after treatment,,without dural sac injury and infection.while in PEID group 2 patient occurred postoperative dysesthesia,1 patients eased after treatment,1 patient was infection which eased after treatment,without dural sac injury.There was no difference between 2 groups(P>0.05).The difference was statistically significant of lumbar and leg JOA scores,VAS scores,ODI scores at the 1st,1st and 3rd months after operation were significantly improved in the two groups(P<0.05),but no significant difference between the two groups(P>0.05).In PETD group,The 1st year after operation were excellent in 46 cases,good in 8 cases,fair in7 cases and poor in 2 cases,while in PEID group,The effects were excellent in 23 cases,good in 4 cases,fair in 3 cases and poor in 1 case,Modified Macnab criteria indicated a similar satisfactory rate of 87.10% and 87.09%.It is no significant difference between the two groups(P>0.05).Conclusion:1.Both the PETD and the PEID endoscopic lumbar discectomy were demonstrated to be safe and effective for L5/S1 disc herniation.2.Compared with PETD,the PEID is superior in less puncture positioning and less operation time,They complement each other in some aspects.3.The operative approach should be chosen according to the herniation type and anatomical characteristics in clinical work.