A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation

Abstract

Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively safe and effective minimally invasive surgery in the treatment of calcified lumbar disc herniation (CLDH). However, studies on percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) for CLDH have rarely been reported. This research aimed to compare the clinical efficacy of PEID and PETD for L5-S1 CLDH. Methods We retrospectively analyzed 54 consecutive patients with L5-S1 CLDH treated with PELD at our institution from August 2016 to August 2020. Patients were divided into PEID group (n = 28) and PETD (n = 26) group according to the surgical methods. The demographic characteristics and surgical results of the two groups were compared. Clinical outcomes were estimated by the visual analog scale (VAS) for leg pain, Oswestry disability index (ODI) and modified MacNab criteria. Results All patients were successfully operated on by PEID or PETD. No significant differences in the demographic characteristics, intraoperative blood loss, postoperative hospital stay and complication rate were noted between the PEID and PETD groups. The excellent and good rates in the PEID group were similar to those in the PETD group (89.29% vs 88.46%, P = 1.000), whereas the PEID group exhibited superior results for operative time (min) (64.61 ± 5.60 vs 85.58 ± 8.52, P < 0.001) and fluoroscopy times (n) (2.93 ± 0.90 vs 13.35 ± 2.30, P < 0.001) compared with the PETD group. Conclusions PEID has achieved good clinical efficacy as PETD for L5-S1 CLDH. Compared with PETD, PEID has the advantages of shorter operative time and a reduced number of fluoroscopy times in the treatment of CLDH.

Transforaminal Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

“…As shown in Figure 2B , the estimated blood loss during the surgery was reported in only 4 studies including 564 patients. 12 , 16 , 20 , 21 The test for heterogeneity revealed no significant heterogeneity existed (P = .12, I 2 = 48%) and the fixed-effect model was used. TELD group demonstrated statistically significantly higher blood loss than participants in the IELD (MD = 1.21 ml; 95% CI: .1-2.32; P = .03).…”

“…A total of 8 studies documented the radiation exposure via fluoroscopy time, including 359 patients in TELD group and 355 patients in IELD group. 12 , 15 - 19 , 23 , 24 The analysis indicated the heterogeneity was high (P < .00001, I 2 = 92%) and the random effect model was used. The study by Liu et al 17 that focused on surgery of highly migrated disc herniation revealed higher fluoroscopic time in IELD than other studies and this study was the resource of heterogeneity.…”

“…The early postoperative ODI improvement was available in 7 studies. 12 , 14 , 18 , 20 , 22 , 24 , 25 The fixed-effect model was used since the heterogeneity was low (P = .40, I 2 = 3%). As depicted in Figure 3A , the postoperative ODI improvement was significantly better following the TELD than the IELD group (MD = −1.26; 95% CI: .07-2.16; P = .04).…”

“…The ODI improvement at the final follow up period was available in 14 studies. 12 - 16 , 18 - 24 , 26 , 27 Moderate heterogeneity was detected (P = .03, I 2 = 46%) and the fixed-effect model was used. As illustrated in Figure 3B , the last follow-up ODI was not significantly different between both approaches (MD = −.32; 95% CI: −1.17-.54; P = .47).…”

“…At the last follow-up, the VASL improvement was available in 12 studies. 12 , 14 , 15 , 18 - 24 , 26 , 27 Moderate heterogeneity was detected (P = .004, I 2 = 60%) and the random-effect model was used. The source of heterogeneity was from Huang et al 15 As illustrated in Figure 3D , the last follow-up VASL was not significantly different between both approaches (MD = .16; 95% CI: −.06-.38; P = .15) ( Fig.…”