A case-control study on the treatment of protrusion of lumbar intervertebral disc through PELD and MED

Abstract

We compared the clinical effects between the percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) treatments for protrusion of lumbar intervertebral disc. We conducted a retrospective analysis on 60 patients who were diagnosed with single-segment protrusion of lumbar intervertebral disc during the period from January 2009 to June 2016. Patients were divided into two groups, the PELD and MED groups, which contained 30 cases each. We evaluated the operation results according to oswestry dysfunction index (ODI), visual analogue scale (VAS) and the improved MacNab standard. The average follow-up visit period after the operation was 18 months and the operation time of the two groups was not statistically different. The cadaverine quantity of bleeding in the PELD group is less than that in the MED group. Moreover, the average length of incision and the length of stay were shortened for the PELD group compared to the MED group. The ODI and VAS after operation for the two groups improved significantly compared to that before operation (P<0.05). The qualified rates of the PELD and MED groups were 93.0 and 90.0%, respectively, as of the improved MacNab method. The complication occurrence rates for the two groups during perioperative period were not different. Therefore, the short-term efficacy of the two minimally invasive operation methods (PELD and MED) on the treatment of protrusion of lumbar intervertebral disc is satisfactory. In cases where operation indications are chosen strictly, PELD can be regarded as a method of safety and efficiency due to the advantages of minimal incision, less bleeding, minimal trauma and faster postoperative recovery.

Keywords: microendoscopic discectomy; percutaneous endoscopic lumbar discectomy; protrusion of lumbar intervertebral disc.

Figure 1.

Images for a typical MED case. (A) MRI shows L5/S1 diskal hernia; (B) MRI shows L5/S1 diskal hernia; (C) nucleus pulposus is removed under diskoscope in surgery; (D) nerve root is deboned under diskoscope after nucleus pulposus is taken out; and (E) MED operative incisions. MED, microendoscopic discectomy; MRI, magnetic resonance imaging.

Figure 2.

Images for a typical PELD case. (A) CT shows L4/5 diskal hernia before surgery; (B) MRI shows L4/5 diskal hernia before surgery; (C) puncture and radiography; (D) puncture and radiography; (E) positioning of the tube; (F) positioning of the tube; (G) the tube in the body; (H) a large nucleus pulposus is removed; (I) nucleus pulposus is removed; (J) nerve root deboned under PELD; and (K) PELD operative incisions. PELD, percutaneous endoscopic lumbar discectomy; CT, computed tomography; MRI, magnetic resonance imaging.