Analysis And Comparison Of The Efficacy Of Two Different Approaches Of PELD In The Treatment Of Recurrent Lumbar Disc Herniation

Objective:Evaluation of the short-term clinical outcomes of Percutaneous Endoscopic Lumbar Discectomy(PELD)in the treatment of single-segment recurrent lumbar disc herniation,and comparison of the clinical efficacy,advantages and disadvantages between the posterolateral transforaminal approach(PETD)and the posterior interlaminarl approach(PEID).Methods: 44 patients with RLDH which were treated with PELD after ineffective conservative treatment,were collected from the Department ofMinimally Invasive Spine,Sichuan Orthopedic Hospital,between March 2016 to March 2018.25 patients were treated in posterolateral transforaminal approach,while the other in posterior interlaminarl approach.Comparison of the lumbar and leg pain VAS score,Oswestry disability index,postoperative excellent rate of efficacy and complications between the two groups with a follow-up visit at least 6 months.Results:1.The VAS score of preoperative low back pain was 7.00±0.76 in the PETD group,3.00±0.50 after operation,2.20±0.71 3 months after operation,1.76±0.78 after 6 months postoperatively,1.60±0.65 at the last follow-up.In the PEID group,it was 6.69±0.67,3.05 ± 0.40,2.37 ± 0.90,2.05 ± 1.22 and 1.52±0.61 respectively.The VAS scores of the both groups were significantly reduced than those before operation,and the difference was statistically significant(P<0.01),but no significant difference of the VAS score has been found in every period between the two groups(P>0.05).2.The preoperative ODI score was 57.25% ±17.92% in the PETD group,13.88%±5.56% 3 months after operation,9.79% ±3.76% after 6 months postoperatively and 8.92%±4.67% at the last follow-up.It was 50.99% ± 15.93%,15.62%± 9.89%,16.64% ±16.40% and 9.43% ± 4.73% in the PEID group respectively.The ODI scores of the two groups were significantly lower than those before operation,and the difference was statistically significant(P<0.01).But there was no significant difference between the two groups(P>0.05).3.In the PETD group,the modified Macnab score was excellent in 11 cases,11 cases were good,2 cases were fair,and 1 case was poor.the excellent and good rate was 88%.In the PEID group,9 excellent and 8 good,1 fair and 1 poor,and the excellent and good rate was 89.5%.There was no significant difference between the two groups(P>0.05).The overall excellent and good rate was 88.6%.4.Complications mainly included:3 cases of postoperative residual symptoms(2 cases of PETD,1 case of PEID),1 case of postoperative symptom recurrence(1 case of PETD,0 case of PEID),1 case of intervertebral space infection(0 case of PETD,1 case of PEID).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Under the strict indication,the clinical outcome of RLDH treated by PELD is effective,with small trauma,short bed time and low complication rate.PETD has comparable clinical outcomes and safety compared with PEID,and its indications complement and overlap with the latter.Both of the two approaches can be considered ideal options for RLDH.