PETD Versus PEID For The Treatment Of L₅/S₁ Disc Herniation:Outcomes And Approaches

Objective By comparing radiological data and surgical related data of percutaneous endoscopic interlaminar discectomy(PEID)and percutaneous endoscopic transforaminal discectomy(PETD)in the treatment of L5/S1 lumbar disc herniation(LDH)and short-term outcome between the two surgical techniques.We hope to provide a choice of L5/S1 disc herniation approach for the surgeon.Methods Sixty-four patients with L5/S1 disc herniation(thirty cases of interlaminar approach surgery,thirty-four cases of intervertebral transforaminal approach surgery)were received in Dalian Municipal Central Hospital,from April 2016 to June 2018.Retrospective analysis was made to compare demographic data(age,gender);radiological data(type of LDH,location of LDH,giant LDH,marginal LDH,calcification LDH,height of intervertebral foramen,height and width of interlaminar space height of iliac crest,height of intervertebral space);surgical data(operation time,intraoperative fluoroscopy times,hospitalization time,bed rest time,operative incision.Visual analog scales(VAS)and Oswestry disability index(ODI)were performed before and after surgery,and the modified Macnab criteria were used to evaluate the outcome of the surgery at the last follow-up.Results Both groups completed the operation successfully.There was no significant difference in general data(P>0.05).In the radiological data,there was no significant difference in the direction of the disc,whether it was a giant disc,whether there was alcified,the height of the iliac crest,the height and width of the interlaminar space,the height of the intervertebral foramen and the height of the intervertebral space(P>0.05).There was a significant difference in the position,type of herniation,and grade of migration(P<0.05).The VAS score and ODI index of the two groups were significantly lower than those before the operation(P<0.01).The first day's VAS score and ODI index after surgery of the two groups were significantly lower before operation(P<0.01).The VAS score and ODI index were significantly lower on the first day and the last follow-up(P<0.01),but there was no significant difference in VAS score and ODI index between the two groups(P>0.05).At the last follow-up,the modified Macnab criteria were used to evaluate the curative effect.The PEID group was excellent in 18 cases,good in 9 cases,and fair in 2 cases.The excellent and good rate was 90%.The PETD group was excellent in 20 cases,good in 11 cases,and fair in 2 cases.The excellent and good rate was 91%.Conclusion Both endoscopic interlaminar and transforaminal approach for the treatment of L5/S1 disc herniation are safe and effective surgical procedure;interlaminar approach can significantly reduce the time of surgery and intraoperative fluoroscopy times;The two procedures have different indications when treating different types of disc herniation.In combination with intraoperative experience,we believe that the application of PETD in central disc herniation is more suitable;PEID is more advantageous for the axillary type,the highly migrated type,and the calcified disc;The Shoulder type herniation should comprehensively consider the height of the iliac and the size of the interlaminar space to determine the operation mode;the mixed type disc herniation needs to combine the relationship of the herniation tissue and the nerve and the size of the herniated tissue to determine the operation approach.