Comparison Of Interlaminar And Transforaminal Approach For Percutaneos Endoscopic Lumbar Discectomy

Objectives Comparison of percutaneous endoscopic treatment of L4/5 intervertebral disc herniation by intervertebral foramen approach and intervertebral disc approach.Method Collected from July 2014 to July 2016 Chengdu University of Traditional Chinese Medicine Hospital inpatient L4/5 disc herniation patients,a total of 61 cases,were conservative treatment ineffective,to take "percutaneous endoscopic L4/5intervertebral disc nucleus removal ",30 cases were treated by intervertebral foramen(TF group),31 cases were treated by laminectomy group(IL group).Comparison of the general condition,clinical manifestations,the number of fluoroscopy,the operation time,the two groups of patients before surgery,1 day after surgery,postoperative March leg pain VAS score,Oswestry disability index,Postoperative excellent rate of efficacy and complications.Results1)The number of fluoroscopy in the intervertebral foramen group(TF group)and the intervertebral disc approach group(IL group)was 9.00 ± 1.28 times and 5.22 ± 1.38 times respectively.The operation time was 70.73 ± 3.63 min,61.96 ± 4.57 min.2)The VAS score of the intervertebral foramen group was 8.26 ± 0.69 before operation,1.90 ± 0.88 1 day after surgery,1.50 ± 0.69 in March.The VAS score of the lumbar intervertebral approach group was 8.29 ± 0.73 before operation,1.83 ± 0.82 after 1 day,1.25 ± 0.72.Two groups of patients after 1 day compared with preoperative VAS score was significantly reduced,after surgery in March compared with preoperative VAS score was significantly reduced,were statistically significance.The results were not statistically significant(P > 0.05)in both groups of patients 1 day after surgery and 3 months after surgery.3)The ODI score of the intervertebral foramen group was 59.81 ± 5.66 before operation and 16.33 ± 3.47 in March,the lumbar intervertebral approach group was59.34 ± 9.13 before operation and 14.87 ± 2.29 in March.The ODI score was significantly lower in the two groups after surgery compared with preoperatively.There was no significant difference in the two groups of ODI score before and after operation(P> 0.05).4)The excellent and good rate was 83.3% in the intervertebral foramen group and87.0% in the lumbar intervertebral approach group.After statistical analysis,P> 0.05,there was no statistical significance.The overall excellent and good rate of the two groups was 85.2%.Conclusion Endoscopic treatment of lumbar disc herniation is effective,the recovery time is short.The intervertebral foramen approach and the intervertebral approach between the two surgical procedures in the postoperative efficacy comparison is not significant,the surgery time of the intervertebral approach was shorter than the intervertebral foramen,and the number of intraoperative fluoroscopy was less,but the intervertebral approach more easily stimulate the nerve root,so these two minimally invasive programs have their own advantages and disadvantages.The patients of the high Iliac crest are suited for laminectomy,laminectomy stenosis are suited for intervertebral foramen approach,highlight the upward or downward migration is more suited for intervertebral approach,prominent in the extreme outside is not suited for intervertebral approach,so comprehensive evaluation of the patient's anatomy,image localization and clinical phenotype to develop appropriate individualized surgical approach to obtain excellent clinical efficacy.