The therapeutic effect of percutaneous transforaminal endoscopic discectomy through interlaminar approach for treating lumbar disc herniation

Abstract

Objective To evaluate the therapeutic efficacy of percutaneous transforaminal endoscopic discectomy (PTED) through interlaminar approach in the treatment of lumbar disc herniation (LDH).  Methods From October 2013 to January 2015, 54 LDH patients underwent PTED by using transforaminal endoscopic spine system (TESSYS) in our hospitial. CT or MRI indicated L_4-5 disc herniation in 13 patients and L₅-S₁ disc herniation in other 41 patients. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of pain in the low back and leg before operation, one day, 3 months and one year after operation. MRI was performed after operation to assess if the nucleus pulposus was removed completely and whether there was a relapse.  Results The success rate of operations was 96.30% (52/54). Two patients suffered from rupture of spinal dura mater during the surgery, and underwent fenestration laminectomy in turn. The average operation time was 58.35 min and median hospital stay was 3 d. At discharge, pain was disappeared in 52 patients and relieved in 2 patients, however, 5 patients presented worsened numbness of lateral lower leg. Compared with preoperation, VAS and ODI scores decreased significantly one day, 3 months and one year after operation (P = 0.000, for all). Lumbar MRI one day after operation revealed nucleus pulposus had been completely removed and the compression of nerve root had been relieved in all cases. There was no relapse in MRI findings 3 months and one year after operation. No surgical complication, such as infection, was found. One patient with L₅-S₁ disc herniation presented postoperative numbness of S₁ nerve root region caused by heavy stretching of nerve root during the operation, and was improved one month later.  Conclusions Percutaneous transforaminal endoscopic discectomy through interlaminar approach in the treatment of lumbar disc herniation is effective and safe.

DOI: 10.3969/j.issn.1672-6731.2016.04.006