Comparison of Interlaminar and Transforaminal Approaches for Treatment of L5 /S1 Disc Herniation by Percutaneous Endoscopic Discectomy

Abstract

Objective: The aim of this study was to compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) in treating L₅ /S₁ disc herniation.

Methods: A retrospective analysis of 76 patients with L₅ /S₁ intervertebral disc herniation was performed. There were two surgical treatment groups: one with patients receiving PEID and the other with patients receiving PETD. The two groups were compared by length of surgery, times of intraoperative X-ray exposure, postoperative time in bed, length of hospital stay, operative complications, patient's assessment of pain using a visual analogue scale (VAS), and disability using the Oswestry disability index (ODI) before and after surgery.

Results: Subjects in the PEID group were in surgery for 60.90 ± 13.11 min and needed intraoperative X-ray exposure 4.10 ± 1.09 times. Patients in this group were ambulatory by 7.52 ± 1.08 h after surgery and were hospitalized for 5.05 ± 0.92 days. In contrast, patients in the PETD group were in surgery for 84.06 ± 15.58 min and needed intraoperative X ray exposure 12.81 ± 8.46 times. These patients were ambulatory by 7.06 ± 0.91 h after surgery and remained in the hospital for 4.94 ± 0.80 days. Based on these data, operation time and fluoroscopy time were significantly less (P < 0.002 and P < 0.001, respectively) for subjects in the PEID group. However, ambulatory time and hospitalization were similar for both in terms of pain relief and decreased disability, and subjects in both groups responded well to the surgery and showed a significant decrease in both VAS and ODI scores at their 1-year follow-up (P < 0.01). Furthermore, there were no statistically significant differences between the two surgeries in terms of pain relief and decrease in disability.

Conclusion: For L₅ /S₁ disc herniation, PEID and PETD provide similar results for patients. However, PEID has the advantage over PETD in that it is a shorter procedure and exposes the patient to less radiation.

Keywords: Clinical efficacy; Lumbar disc herniation; Minimally invasive spine surgery; PEID; PETD.

Fig 1

(A, B) Schematic diagram of percutaneous endoscopic transforaminal discectomy. (C, D) Schematic diagram of percutaneous endoscopic interlaminar discectomy.

Fig 2

Woman, 45 years old. Main complaint: lateral pain of right leg with numbness for half a year. (A) Preoperative X‐ray films. (B) Preoperative MRI shows that L₅S₁ disc herniation and the protruding nucleus pulposus compresses the dural sac. (C) Preoperative CT image shows L₅S₁ disc herniation. (D) The position of the working cannula using the intervertebral foramen approach. (E) CT image shows that the nucleus pulposus was completely removed.

Fig 3

Male, 42 years old. Main complaint: lumbago for 3 years, with pain and numbness of right lower extremity for 1 month. (A) Preoperative X‐ray films. (B) Preoperative MRI showed L₅S₁ disc herniation. (C) Preoperative CT showed L₅S₁ disc herniation. (D) The position of the working cannula through the inter lamina approach during the operation. (E) CT image after operation shows that the herniated intervertebral disc has been taken out.