Initial Clinical Outcomes Of Percutaneous Full-endoscopic Lumbar Discectomy Using An Interlaminar And Transforaminal Approach At The L4-L5 Disc Herniation

Objective: this study aim to evaluate initial clinical outcomes of IL-PELD and TF-PELD at L4-L5 disc herniation,and evaluate which approach is better.Methods: A retrospective analysis of a total 54 L4-L5 disc herniation patients who underwent interlaminar approach surgery and transforaminal surgery in our institute,including 24 patients peformed Interlamina Percutaneous Endoscopic Lumber Discectomy and 30 patients peformed transforaminal Percutaneous Endoscopic Lumber Discectomy.We collect and compare the data of the two groups such as operation time,intraopertive blood loss and the average length of hospital stay were collected for the two groups respectively.The type of the diseased intervertebral disc was classified according to the preoperative lumbar MRI.Preoperative and postoperative VAS scores(visual analogue scores for pain)were used to assess the degree of low back pain and leg pain before and after surgery.Oswestry dysfunction index(ODI index)and modified MacNab criteria were used to evaluate postoperative functional recovery.Result: All patients completed the operation successfully.There was no significant difference in age and gender between the two groups(P>0.05).The VAS scores,ODI,and low back pain and leg pain at 1 day,3 months,and 6 months after operation in both groups.The scores were significantly lower than those before surgery(P<0.05).There was no significant difference in the mean operation time,average length of hospital stay,waist and leg VAS score,and ODI score between the two groups(P>0.05).According to the improved MacNab criteria,IL group: excellent in 15 cases,good in 6 cases,fair in 3 cases,poor in 0 cases;TF group: excellent in 20 cases,good in 7 cases,fair in 3 cases,poor in 0 cases,there was no significant difference between the two groups.Difference(P>0.05).However,there was a significant difference between the two groups in the TF group and the IL group.In the TF group,the ratio of the supraspinal type(21 cases,71%)was higher than the subdiaphragmatic type(9 cases,29%);in the IL group,the The lower type(20 cases,83%)was higher than the shoulder type(4 cases,17%)(P < 0.05).Four cases of lateral prominence were all treated with TF-PELD,8 cases of highly translocated patients received IL-PELD,and only 1 case was treated with TF-PELD.Conclusions: The short-term efficacy of IL-PELD and TF-PELD in the treatment of L4/L5 disc herniation is comparable,and good short-term efficacy can be obtained,but IL-PELD is used for patients with central disc type,subdiaphragmatic type and high degree of dislocation.It is more advantageous,but TF-PELD is more appropriate for patients with intervertebral disc types of suprascapular and lateral types.