Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

Abstract

Background: Very few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis.

Materials and methods: The clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded.

Results: Three patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all P<0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (P<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%.

Conclusion: TED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH.

Keywords: common peroneal nerve paralysis; lumbar disk herniation; minimally invasive surgery; transforaminal endoscopic discectomy.

Figure 1

A case of transforaminal endoscopic discectomy surgery. Notes: Anteroposterior and lateral position X-ray radiographs indicate the location of the spinal needle (A and B); anteroposterior and lateral position X-ray radiographs indicate the location of the guide bar (C and D); the serrated reamer was utilized for zygapophyseal plasty, and the front end of the serrated reamer should not exceed the inner edge of pedicle of vertebral arch (E); placed the working channel (F); extracted the prolapse of nucleus pulposus (G); and sufficient decompression of the nerve root was seen under the endoscope (H).

Figure 2

The MRI and X-ray changes. Notes: Preoperative MRI in sagittal position (A); sagittal MRI immediately after surgery (B); sagittal MRI 3 months after surgery (C); sagittal MRI 24 months after surgery (D); preoperative MRI in coronal position (E); coronal MRI 3 months after surgery (F); coronal MRI 24 months after surgery (G); preoperative X-ray radiograph in lumbar dynamic position showing no lumbar instability or spondylolysis (H); reexamination X-ray radiograph in lumbar dynamic position 24 months postoperatively showing no lumbar instability (I). Abbreviation: MRI, magnetic resonance imaging.

Figure 3

(A) Grade 1 preoperative anterior tibial muscle strength of the left lower extremity. (B) Grade 4 anterior tibial muscle strength of the left lower extremity immediately after the surgery.