| Objective: To investigate appropriate operative route,which according to the relationship of the position between the nerve root and protrusive disc on the MRI for the treatment with the L5/S1 lumbar disc herniation via the percutanuos full-endoscopic interlaminar lumbar discectomy(PEID).Methods: Forty-seven patients with L5/S1 LDH,which were divided into three types: axilla,shoulder and ventral,according to the primary position of the protrusive disc with a compressed nerve root on axial MRI,satisfied the inclusion criteria and underwent the different strategies of PEID successfully during the period from August 2015 to June 2017.The axilla approach was chosen for axilla-type protrusion of 20 cases,while the shoulder approach was selected for shoulder–type protrusion of 11 cases and the surrounding nerve root discectomy(SNRD)was chosen for ventral-type protrusion of 16 cases.The operation times,bleeding volumes,removed disc tissue volumes,and intraoperative complications were recorded for each patient.And MRI was used to evaluate the completeness of resection of protrusive disc tissue in each patient with in one week.The visual analogue scale(VAS)and the Oswestry low-back pain disability questionnaire criteria(ODI)were used to evaluate the pre-and postoperative clinical results.The Modified Macnab criteria were applied to evaluate the final clinical results.Results: All operations were completed successfully without conversion to other surgical techniques.The average operation time was 96.76 min.The average removed disc tissue volume was 2.8ml.The blood of intraoperation was too less to observed.No nerve root and the dural sac injury,infection,or other complications occurred.MRI indicated that the protrusive disc tissue was removed completely postsurgery.For the axilla type(20 cases)with the axilla approach,the average operation time was 95.05 min.The average removed disc tissue volume was 2.775 ml.The VAS scores at week 1(2.40±0.75)as well as at months 3(1.65±0.59)and 6(0.85±0.59)after the operation,were significantly decreased compared to the preoperative VAS score(7.40±1.14)(P<0.05).The ODI scores also showed a significant decrease from(68.83±12.02)% preoperatively to(15.11±4.71)% at week 1,(11.18±5.07)% at month 3,(8.41±3.95)% at month 6 after surgery(P<0.05),The MacNab scores at the 6-month follow-up included 18 excellent and 2 good scores.For the shoulder type(11 cases)with the shoulder approach,the average operation time was 90 min.The average removed disc tissue volume was 2.35 ml.The VAS scores at week 1(2.09±0.70)as well as at months 3(1.64±0.50)and 6(0.73±0.47)after the operation,were significantly decreased compared to the preoperative VAS score(7.09±1.38)(P<0.05).The ODI scores also showed a significant decrease from(69.70±12.14)% preoperatively to(14.82±4.58)% at week 1,(10.92±4.77)% at month 3,(8.07±4.03)% at month 6 after surgery(P<0.05),The MacNab scores at the 6-month follow-up included 10 excellent and 1 good scores.For the ventral type(16 cases)with the SNRD,the average operation time was 103.56 min.The average removed disc tissue volume was 3.14 ml.The VAS scores at week 1(2.25±0.86)as well as at months 3(1.63±0.62)and 6(0.81±0.54)after the operation,were significantly decreased compared to the preoperative VAS score(7.19±1.33)(P<0.05).The ODI scores also showed a significant decrease from(69.76±11.51)% preoperatively to(14.66±4.94)% at week 1,(11.33±4.97)% at month 3,(8.35±3.55)% at month 6 after surgery(P<0.05),The MacNab scores at the 6-month follow-up included 13 excellent,2 good scores,1 poor scores and 0 fair scores.Conclusion: According to the relationship of the position between the nerve root and protrusive disc on the MRI,the axilla-type protrusion via the axilla approach,while the shoulder–type protrusion via the shoulder approach and ventral-type protrusion via the surrounding nerve root discectomy(SNRD)of the PEID,which has the advantages for the completeness of resection of protrusive disc tissue,has the important reference value. |
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