A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study

Abstract

Objective To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside‐out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH). Method A total of 135 patients with symptomatic LDH who were treated by inside‐out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved. Results The VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow‐up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64–21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29–6.51, P = 0.025), pre‐ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41–14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow‐up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551). Conclusion The PLL is recommended to be retained for inside‐out PETD surgery.

Automated Magnetic Resonance Image Segmentation of Spinal Structures at the L4‐5 Level with Deep Learning: 3D Reconstruction of Lumbar Intervertebral Foramen

“…The lumbar intervertebral foramen (LIVF) approach is a common surgical approach of percutaneous endoscopic discectomy (PED) for treating lumbar disc herniation and spinal stenosis 1,2 . Establishing an appropriate working channel as well as planning an optimal trajectory are prerequisites to the success of PED 3 .…”

“…The lumbar intervertebral foramen (LIVF) approach is a common surgical approach of percutaneous endoscopic discectomy (PED) for treating lumbar disc herniation and spinal stenosis. 1 , 2 Establishing an appropriate working channel as well as planning an optimal trajectory are prerequisites to the success of PED. 3 The optimal trajectory is critical to the successful entry of the obturator, endoscope, and other relevant instruments into the lumbar intervertebral foramen.…”

Normative Measurements of L1–S1 Segmental Angulation, Disk Space Height, and Neuroforaminal Dimensions Using Computed Tomography

“…0 <.001 À.6 <.001 À2 7. 1.000 1.2 <.001 À.3 .525 À.9 1.000 À3.6 <.001 À2.7 <.001 À1.8 <.001 À1.7 <.001 .2 1.000 À.1 1.000 À.9 1.000 .3 1.000 .1 1.000 1.7 1.000 À1.2 <.001 À.9 <.001 À.6 <.001 L4-L5 À4.7 <.001 .7 <.001 .6 <.001 6.8 <.001 .9 <.001 1.0 <.001 10.1 <.001 À2.7 <.001 À1.3 <.001 À.8 <.001 4.7 <.001 À.7 <.001 À.6 <.001 À6.8 <.001 À.9 <.001 À1.0 <.001 À10.1 <.001 2.7 <.001 1.3 <.001 .8 <.001 L3-L4 2.9 <.001 À.6 <.001 À.7 <.001 À7.8 <.001 À.6 .002 À.8 <.001 À8.4 <.DSH, disk space height; MD, mean difference; NFD, neuroforaminal dimension; SA, segmental angulation.…”

“…Understanding NFDs, specifically, is important for surgical intervention such as endoscopic foraminotomy or percutaneous endoscopic diskectomy (PED) and medical diagnoses such as lumbar neuroforaminal stenosis (LNFS). 6,7 With a steep learning curve, thorough knowledge of NFDs is critical for the successful approach strategy of the PED working channel and trajectory. In doing so, successful navigation of the obturator and endoscope instruments may be achieved and hence a decrease in fluoroscopy frequency, operation time, and incomplete endoscopic views.…”