Percutaneous endoscopic interlaminar discectomy of L5-S1 disc herniation: a comparison between intermittent endoscopy technique and full endoscopy technique

Abstract

Background: Percutaneous endoscopic laminar discectomy is a typical minimally invasive discectomy operation that is classified into the percutaneous endoscopic transforaminal discectomy and the percutaneous endoscopic interlaminar discectomy. Based on whether the surgeon chooses to deal with the ligamentum flavum under endoscope guidance, percutaneous endoscopic discectomy by the interlaminar approach can be performed with a full endoscope technique with the intermittent endoscope technique. To our knowledge, there is no study comparing these two techniques in regard to their surgical effects and advantages. Therefore, we conducted this study to compare the cost, safety, and efficacy between the intermittent endoscopy technique and full endoscopy technique of endoscopic interlaminar lumbar discectomy at the L5-S1 level.

Methods: From September 2014 to March 2015, a total of 126 patients with radiculopathy due to L5-S1 disc herniation who were treated by a full endoscopy technique (65 patients) or intermittent endoscopy technique (61 patients) were included. Relevant data, such as duration time of the operation, hospitalization expenses, postoperative bed rest time, length of hospitalization, and complication rates, were recorded. Clinical outcomes were assessed by the visual analog scale score, modified MacNab criteria, and Oswestry disability index.

Results: In the full endoscope (FE) group, the mean duration time of surgery was 75.0 ± 11.9 min. The postoperative bed rest time was 6.5 ± 1.1 h, length of hospitalization was 3.8 ± 1.1 days, and complication rate was 7.69%. In the intermittent endoscopy (IE) group, the mean duration time of surgery was 43.0 ± 16.4 min. The postoperative bed rest time was 5.0 ± 1.1 h, length of hospitalization was 3.6 ± 1.2 days, and complication rate was 6.60%. The average hospitalization expenses of the FE group and IE group, respectively, were 32,069 ± 1086 RMB and 22,665 ± 899 RMB. There were significant differences in the surgical duration and hospitalization expenses (P < 0.01), but no differences between the two groups in postoperative bed rest time, length of hospitalization, or complication rates (P > 0.05). The postoperative Oswestry disability index and VAS were clearly improved in both groups compared with those of preoperation (P < 0.01). These two procedures have the same clinical outcomes (P > 0.05).

Conclusions: Both the full endoscopy technique and intermittent endoscopy technique achieved good outcomes, whereas the intermittent endoscopy technique is a more effective option for a shorter duration surgery and lower hospitalization expenses.

Keywords: Clinical outcome; Full endoscopy; Herniated nucleus pulpous; Interlaminar approach; Intermittent endoscopy; Intracanalicular disc herniation; MacNab criteria; Percutaneous endoscopic lumbar discectomy.

Fig. 1

Percutaneous endoscopic interlaminar discectomy using intermittent endoscopy technique for a 40-year-old male patient with L5–S1 disc herniation. a, b Preoperative MRI image showing compression of dura and right S1 nerve root by disc herniation. c, d Place the needle into the disc. Intraoperative x-ray showing the placement of the dilator. e, f The working cannula was rotated in, and the location was confirmed with C-arm fluoroscopy before discectomy. g Intraoperative view in interlaminar access with S1 nerve root (arrow) and the herniation (star). h Intraoperative view in interlaminar access with S1 nerve root (arrow), ruptured annulus fibrosus (star) after removal of the herniation. i Disc pulposus. j, k 31 month postoperative MRI showing removal and good decompression of nerve root and dura