| ObjectiveTo investigate the early and mid-term clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH),and to observe the effect of PTED on the degeneration of the surgical segment and adjacent segments.MethodsA retrospective review of 49 cases with lumbar disc herniation was performed who had undergone percutaneous transforaminal endoscopic discectomy in spine surgery of the First Affiliated Hospital of University of South China from October 2015 to December 2017.The pain and daily activity was evaluated by the visual analogue scale(VAS)and the Oswestry disability index(ODI)respectively.Modified MacNab criteria were employed to measure the clinical results.The preoperative and postoperative lateral lumbar spine X-rays was used to measure the surgical segment,the upper adjacent segment,and the entire lumbar lordosis Cobb angle.Use pre-and post-operative CT reconstruction images to measure the intervertebral space height index(IHI)of the surgical segment and the upper adjacent segment,as well as the facet joint angle(FJA)of the surgical segment.Use pre-and post-operative lumbar spine magnetic resonance Imaging(MRI)to measure the cross-sectional area of the foramen(CSAF)at the surgical segment,the calibrated disc signal(CDS)of the surgical segment and the upper adjacent segment.ResultsAll the 49 patients were operated successfully,and there was one case of cerebrospinal fluid leakage caused by dural sac injury,without epidural hematoma,psoas major hematoma,perforating the intestine,nerve root and cauda equina injury,vascular injury and other related complications.The follow-up period was 31.69±7.45 months(Range,24-46 months).At the last follow-up,recurrence was found in the surgical segments of 3 patients,and the recurrence rate was about 6.1%.The preoperative VAS score of leg pain was 7.98±0.99,3.35±1.33 in Immediate postoperative,and2.06±1.66 in the last follow-up.The preoperative VAS score of low back pain was 7.63±1.75,3.22±1.54 in Immediate postoperative,and 2.43±2.03in the last follow-up,the differences were statistically significant(P<0.05).The preoperative ODI was 70.49±24.21%,21.91±12.06%in Immediate postoperative,and 10.16±9.70%in the last follow-up;the differences were statistically significant(P<0.05).Modified MacNab Criteria:excellent in 28 cases,good in 18 cases,fair in 3 cases,and the excellent and good rate was 93.87%.The angle of Cobb in the operative segment was 10.57±4.50°before operation and 11.73±4.05°in the last follow-up.The Cobb angle of upper adjacent segment was 8.10±3.65°before operation and 9.43±3.17°in the last follow-up.The Cobb angle of lumbar lordosis was 37.67±14.56before operation,and was 40.70±10.86°in the last follow-up,the difference was statistically significant(P<0.05).The preoperative IHI was 33.56±5.51%in the surgical segment,and29.92±5.18%in the last follow-up.The preoperative IHI was 33.87±4.72%in the upper adjacent segment,and 32.37±4.54%in the last follow-up;the differences were statistical Significance(P<0.05).The IHI difference(?IHI)between preoperative and final follow-up was 3.64±5.33%in the surgical segment,and the IHI difference(?IHI)between preoperative and last follow-up was 1.49±2.51%in the upper adjacent segment,which also had statistical significance(P<0.05).The preoperative FJA was 47.14±10.91°on the protruding side of the operative segment,and 47.75±11.07°in the last follow-up.The preoperative FJA of non protruding side was 45.83±12.11°,and 44.79±11.74°in the last follow-up.There was no significant difference(P>0.05).The preoperative CDS was 77.36±22.01%in the surgical segment,and 81.26±27.86%in the last follow-up.The preoperative CDS was 89.62±24.43%in the upper adjacent segment,and 90.43±26.17%in the last follow-up.There was no significant difference(P>0.05).The CDS difference(?CDS)between the last follow-up and preoperative was 3.90±24.27%in the surgical segment,and the CDS difference(?CDS)between the last follow-up and preoperative was 0.81±17.83%in the upper adjacent segment,there was no significant difference(P>0.05).The preoperative CSAF was 88.84±29.60 mm~2 on the protruding side of the operative segment,104.80±33.00 mm~2 in Immediate postoperative,and 87.03±24.17mm~2 in the last follow-up.The preoperative CSAF of non protruding side was 93.58±31.36 mm~2,97.63±26.37 mm~2 in Immediate postoperative,and 88.79±40.55 mm~2 in the last follow-up.The immediate postoperative CSAF of the surgical segment increased significantly compared with the preoperative period,and the difference was statistically significant(P<0.05);However,there was no statistically significant difference between the preoperative and final follow-up of the CSAF at the surgical segment,and between the preoperative and immediate postoperative and last follow-up of the non-protruding CSAF at the surgical segment(P>0.05).ConclusionThe results of short-term follow-up confirmed that the clinical effect of PTED was satisfactory,which did not increase the risk of surgical segment and adjacent segments disc degeneration. |
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