Clinical Study Of PELD About Different Surgical Approaches For The Treatment Of Highly Migrated Lumbar Disc Herniation

Objectives This study analyzed the results of mid-term follow-up of percutaneous endoscopic lumbar discectomy(PELD)that include an interlaminar approach(IL),transforaminal approach(TF)in the treatment of highly migrated lumbar disc herniation(LDH)to investigate the clinical effect,operative skills,matters needing attention of different surgical approaches and responsibility segments for different sur-gical approaches in the treatment of highly prolapsed migrated LDH under PELD.Methods:A total of 57 patients with highly prolapsed migrated LDH were included,including 26 patients in the group IL,30 patients in group TF and 1 patient in the group TF falling off respectively.PELD-IL was used in the group IL,PELD-TF was used in the group TF.Clinical outcomes were assessed with the visual analogue scale(VAS)score,the modified MacNab criteria,and the Oswestry disability index(ODI).All groups were followed up for 6 months.Results:All the 57 patients successfully completed the surgery,including 1 patient in group C with postoperative recurrence 2 months later.All patients received open surgery and their symptoms improved.The ODI decreased from 65.08±17.77 to 13.00±4.43 in the group IL,and from 64.70±15.12 to 15.50±4.46 in the group TF.The ODI of the group IL was better than that of the group TF at 3 months and 6 months postoperative follow-up(P<0.05).VAS-back score and VAS-leg score of the two groups were lower than that before surgery,and there was no significant difference between the two groups at each time point(P>0.05).According to the modified MacNab criteria,the excellent and good rate was 92.31%in the translaminar approach group and 90.00%in the translaminar foraminal approach group.Conclusion:PELD can effectively treat highly prolapsed migrated LDH,including an IL,TF.The interlaminar approach was superior to the translaminar approach.