Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis: A retrospective case-control study

Abstract

The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery.In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared.The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively.PELD operation was superior in terms of operation time, bleeding volume, recovery period, and financial support, if compared with lumbar internal fixation operation. Radiographic parameters reflect lumber structure changes, which could be observed immediately after surgery in both methods; however, the recoveries on nerve function and pain relief required a longer time, especially after PLIF operation.

Figure 1

MRI of lateral position taken preoperatively showed a stable retrolisthesis of lumbar 3 after a previous internal fixation. Patient was a male, 50 years old. Arrow pointed the L3 retrolisthesis. MRI = magnetic resonance imaging.

Figure 2

Before PELD operation, X-ray imaging of lateral position showed the 3 inserted screws in L4-S1 from a previous PLIF operation, and the arrow showed the stable retrolisthesis at L3 from same patient in Figure 1. PELD = percutaneous endoscopic lumbar discectomy, PLIF = posterior lumbar interbody fusion.

Figure 3

The procedure of PELD operation. A, Establishing a work channel on patient's posterolateral position. B, Operation field under the endoscopy. C, Nucleus pulposus clamp. D, Radio-frequency electrode.

Figure 4

Fluoroscopic image was taken intraoperatively: removing disc in the process of PELD.