Percutaneous Endoscopic Lumbar Discectomy For Axillar Herniation At L5-S1 Via The Transforaminal Approach Versus The Interlaminar Approach:A Prospective Clinical Trial

Objective:To evaluate the results of percutaneous endoscopic transforaminal discectomy(PETD)in comparison with percutaneous endoscopic interlaminar discectomy(PEID)for axillar herniation at L5-S1.Methods:From January 2017 to March 2018,80 patients admitted with axillar herniation at L5-S1 were randomly recruited into two groups: 40 cases in the PETD group and 40 in the PEID group.Each group separately underwent PETD or PEID.Patient sex,age,body mass index(BMI),axillar herniation size,number of C-arm fluoroscopies,operation time,postoperative bed time,complications,and clinical effect were compared.Both groups were followed up using the Oswestry Disability Index(ODI),visual analogue scale(VAS)and MacNab criteria.Results:Except for one case in the PETD group that switched to the PEID group,the patients completed the study as expected.All patients were followed up.Preoperative demographics were not significantly different(P > 0.05)between the two groups.The mean number of C-arm fluoroscopies(12.44 ± 3.21)and the operation time(66.49 ± 16.29minutes)of PETD group were significantly improved compared with the PEID group(number of fluoroscopies: 3.41 ± 0.81,P < 0.001;operation time: 53.56 ± 10.82 minutes,P < 0.001),but the postoperative bed rest time and complication rate were not(P > 0.05).The postoperative ODI and VAS scores were obviously improved in both groups when compared with preoperation(P < 0.001).There were no significant differences between the2 groups in MacNab criteria or VAS and ODI scores at the same time point(P > 0.05).Conclusions:For axillar herniation at L5-S1,PEID can ignore the anatomic obstruction with advantages including a shorter operation time and less intraoperative radiation exposure.PETD has a clinical effect similar to that of PEID,but the process of it is more dangerous and harder than PEID.