Clinical outcomes of fenestration discectomy and iLESSYS-Delta interlaminar endoscopic system for treatment of LDH: a single-center retrospective cohort study

Abstract

To compare the clinical efficacy of interlaminar endoscopic surgical system delta (iLESSYS-Delta) discectomy with that of classical fenestration discectomy for treating lumbar disc herniation. Patients who underwent iLESSYS-Delta or fenestration discectomy were enrolled in this study. Baseline information and clinical indicators were collected. The baseline data were matched using propensity score matching. Fifty-two patients were in each group. In the iLESSYS-Delta cohort, the volume of intraoperative bleeding was 18.17 ± 4.20 ml, the length of postoperative hospital stay was 4.16 ± 2.29 days, and the length of postoperative off-bed activity was 1.58 ± 0.88 days. In contrast, in the fenestration group, the volume of intraoperative bleeding was 32.50 ± 17.13 ml, the length of postoperative hospital stay was 6.66 ± 2.44 days, and the length of postoperative off-bed activity was 3.18 ± 1.28 days. The difference between the two groups was statistically significant (P < 0.05). The operation time was 88.90 ± 19.14 min in the iLESSYS-Delta group and 67.63 ± 19.32 min in the fenestration group, and the difference between the two groups was statistically significant (P < 0.05). Regarding the pain visual analogue scale scores at 24, 48, and 72 h after surgery, patients in the iLESSYS-Delta group had less pain than did those in the fenestration group (P < 0.05). The Oswestry disability indices of postoperative patients in both groups significantly improved at 3 months after surgery and at the last follow-up (P < 0.05); however, there was no statistically significant difference in the postoperative ODI scores between the two surgery groups (P > 0.05). The two groups showed no significant differences in clinical effects, postoperative recurrence rates, or perioperative complications. iLESSYS-Delta can cause less intraoperative bleeding and faster recovery than fenestration discectomy.

Keywords: Discectomy; Fenestration; Lumbar disc herniation; Propensity score matching; iLESSYS-delta.

Fig. 1

Propensity score matching. (A) Q‒Q plot comparing the probability distributions of the two surgical groups with regard to covariates. The results show that although the matched point is not precisely on the y = x-line, it significantly improves compared to that before matching. (B) Histogram showing the distribution density of the propensity scores before and after matching the two surgical groups. The propensity scores of the prematch treatment group were significantly greater than those of the control group. After matching, the density distributions of the two groups became similar. (C) Jittered plot showing the matched and nonmatched observations. The distribution of the propensity scores was similar between the matched groups.