Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

Abstract

BackgroundVery few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis.Materials and methodsThe clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded.ResultsThree patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all P<0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (P<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%.ConclusionTED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH.

Prognosis for Recovery of Foot Drop after Transforaminal Endoscopic Decompression of Far Lateral Lumbar 5-Sacral 1 Herniated Disc: Case Series

“…Although L4-5 disc herniation is the most common lumbar pathology to cause foot drop, L5-S1 disc herniation can be identified as the cause in up to 25% of cases (10). Often, disc herniations at this level are in a far lateral position that can affect the exiting L5 nerve root, with or without compression of the traversing S1 nerve root.…”

“…The patient had significant improvement of pain and full resolution of foot drop after the procedure, although the authors cite that root compression causing foot drop could be worsened by device landing and irrigating pressure from endoscopic techniques (20). Wang et al (10) subsequently performed an analysis of 32 patients receiving transforaminal endoscopic discectomy for LDH causing foot drop, 8 of which had L5-S1 disc herniation. Overall, most of their patients recovered to 4/5 or greater strength, however, they did not report specific results for the subgroup of patients with L5-S1 disc herniation or specify if they were in a far lateral position (10).…”

“…Wang et al (10) subsequently performed an analysis of 32 patients receiving transforaminal endoscopic discectomy for LDH causing foot drop, 8 of which had L5-S1 disc herniation. Overall, most of their patients recovered to 4/5 or greater strength, however, they did not report specific results for the subgroup of patients with L5-S1 disc herniation or specify if they were in a far lateral position (10).…”

Endoscopic transforaminal lumbar discectomy in the treatment of multilevel disc herniations

“…Lumbar disc herniation in adults is characterized by the pain of leg and back pain due to disk degeneration, which involves a multitude of cellular and biochemical changes. [29,16,13] Discectomy was safe and effective surgery for disc herniation, and the decision about open or endoscopic discectomy to perform should mainly be based on the pathologic features of the lumbar spine. [11,20,24] Disc prolapse almost always start with an insidious onset of back pain followed at a later stage by root pain, and the appearance of the root pain may be accompanied by reduction or loss of the back pain.…”

“…The endoscopic techniques rely heavily on the skill and experienced endoscopic surgeon, as well as the patient's anatomy relative to the location of the herniation and the ability to access the herniation. [29,30,3] The aim of endoscopic discectomy was to relieve sciatica pain in disc herniation patients, which it's easy to decide and perform the surgery in one level disc herniation. However, the delimitation remains on the condition of two level disc herniation patients.…”