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. 2023 Jul 5;18(1):483.
doi: 10.1186/s13018-023-03967-3.

One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique

Yuhong Zhang  1 , Bo Feng  2 , Huaxiu Ning  1 , Guohua Dai  1 , Weiliang Su  1 , Huaiwang Lu  1 , Peng Hu  3
Affiliations

One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique

Yuhong Zhang et al. J Orthop Surg Res. .

Abstract

Background: Lumbar disc herniation (LDH) is one of the most common diseases of the spine, and migrated LDH is a more serious type, associated with nerve root function injury or abnormality. Regarding the increasing surgery adoption of treating migrated LDH, we aimed to investigate the clinical efficacy and safety of discectomy with a novel technique-one-hole split endoscope (OSE) technique.

Methods: This was a retrospective analysis of migrated LDH treated between December 2020 and September 2021. Hospitalization time, operative duration, intraoperative blood loss, number of fluoroscopy exposures, incision length, postoperative facet preservation rate, number of excellent-good cases, lower back and leg visual analogue score (VAS), Oswestry Disability Index (ODI) and surgical complications were compared between high-grade migration group (82 cases) and low-grade migration group (148 cases). The Macnab criteria was used to evaluate the clinical outcome. The Shapiro‒Wilk test was used to test measurement data, and the χ2 test was used to test counting data.

Results: There was no significant difference in hospitalization time, operative duration, intraoperative blood loss, number of fluoroscopy exposures, incision length or postoperative facet preservation rate between the two groups by independent sample t test or nonparametric test. At any time point, the lower back and leg VAS and ODI of the two groups were significantly improved compared to those before the operation, but there was no significant difference between the two groups at the same time point by two-way repeated measures ANOVA. There were two cases of postoperative nerve root stimulation symptoms in the high-grade migration group and three cases in the low-grade migration group. There was one patient reoperated in the high-grade migration group. There was no significant difference in number of excellent-good cases between the two groups. The overall excellent-good rate was 89.6%.

Conclusion: The OSE technique has the advantages of less trauma, faster recovery, complete removal of the nucleus pulposus and a satisfactory early clinical efficacy in the treatment of migrated LDH.

Keywords: Clinical efficacy; Complication; Migrated lumbar disc herniation; One-hole split endoscope technique.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
A, B The postoperative facet preservation rate was assessed by measuring the axial articular surface length of the preoperative and postoperative responsible segments on lumbar horizontal CT scan image. Postoperative facet preservation rate = b/a × 100%
Fig. 2
Fig. 2
Bar charts show the results of preoperative and postoperative the third day, three months and the last follow-up VAS of lower back and leg pain in terms of mean, with the vertical line representing the SD. ***Represents the significant difference for the pairwise comparison in the high-grade migration group (P < 0.0001). ♢♢♢Represents the significant difference for the pairwise comparison in the low-grade migration group (P < 0.0001)
Fig. 3
Fig. 3
Bar charts show the results of preoperative and postoperative three months and the last follow-up ODI in terms of mean, with the vertical line representing the SD. ***Represents the significant difference for the pairwise comparison in the high-grade migration group (P < 0.0001). ♢♢♢Represents the significant difference for the pairwise comparison in the low-grade migration group (P < 0.0001)
Fig. 4
Fig. 4
A 48-year-old female was diagnosed preoperatively with high-grade migrated LDH at the L4–5 level and underwent discectomy by OSE. A, B The preoperative T2-weighted MR images showed that the migrated intervertebral disc was located in zone 4. C Intraoperative anteroposterior fluoroscopy was used to confirm the responsible segment. D, E Images under the endoscope. F The nucleus pulposus tissue. G, H The postoperative T2-weighted MR images showed that the migrated intervertebral disc was completely removed. I The 3D CT showed that partial bone defected
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