Comparative Study Of Degree Of Nerve Root Stimulation And Therapeutic Effect Between Percutaneous Endoscopic Interlaminar Discectomy And Fenestration Laminectomy

Objective To compare degree of nerve root stimulation of percutaneous endoscopic interlaminar discectomy and fenestration laminectomy and therapeutic effect by application of free running electromyogram(f-EMG)for nerve root monitoring during lumbar surgery and symptom score.Metheods From December 2015 to January 2017,33 cases with simply lumbar disc herniation underwent PTED or FL by randomizationand.There were 26 males and 7 females.The mean age was 40.21±10.86 years(20-65 years)and the mean course was 6.97±9.41 months(1-36 months).17 patients were treat with PEID and 16 patients were treat with FL.ALL patients used the f-EMG for nerve root monitoring during lumbar surgery and compared intraoperative EMG activity,duration,length of incision,hospitalization duration after operative,the score of VAS and ODI before operation,the score of VAS and ODI after operation of the two groups.Results The minimum time of follow-up for patients is 6 months and the mean time of follow-up is 9.29±2.74 months.From the analysis of record:The mean of intraoperative EMG activity in PEID group(24.53±4.06)were less than FL groups(29.88±4.11)(P<0.01).The mean of the single burst EMG activity in PEID group(24.06±3.75)were less than FL groups(28.69±3.94)(P<0.05).The mean of the sustained burst EMG activity in PEID group(0.47±0.62)were less than FL groups(1.19±1.05)(P<0.05).The average proportion of the single burst EMG activity in PEID group(98.25%±2.23%)were more than FL groups(96.08±3.15)(P<0.05).The average proportion of the sustained burst EMG activity in PEID group(1.75%±2.23%)were more than FL groups(3.92%%±3.15%)(P<0.05).There were no significant differences in operative duration between the PEID group(94.76±14.98 min)and the FL groups(93.31±9.73)(P>0.05).The mean of irradiation in PEID group(10.47±2.29)were more than FL groups(3.88±0.62)(P<0.01).The average length of incision in PEID group(0.85±0.08 cm)were shorter than FL groups(4.94±0.36 cm)(P<0.01).The average hospitalization duration after operative in PEID group(4.18± 1.24)were less than FL groups(10.13±2.73)(P<0.01).The VAS sore of first postoperative day in PEID group(1.85±0.49)were lower than FL group(2.50±0.86)(P<0.05).There were no significant differences in VAS score at week after operation,month after operation,3 month after operation and 6 month after operation between the PEID group and the FL groups(P>0.05).The VAS sore at 6 month after operation in PEID group and FL group were lower than the Preoperative score(P<0.01).There were no significant differences in ODI score at 3 month after operation and 6 month after operation between the PEID group and the FL groups(P>0.05).The ODI sore at 6 month after operation in PEID group and FL group were lower than the Preoperative score(P<0.01).The excellent rate of PEID group and FL group is 100%according to the MacNab criteria and there were no significant(P>0.05)between the groups.Conclusion The short-term curative effect of the PEID and the FL is similar in the treatment of the simply lumbar disc herniation.But the PEID have more advantages than FL in length of incision and hospitalization duration after operative.And the amount of intraoperative nerve root stimulation by the PEID is fewer.