Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Abstract

Background: Approximately one-third patients with lumbar disc herniation (LDH) showed postoperative reactive pain, and this reactive pain may be related to the postoperative increased release of inflammatory mediators. Percutaneous transforaminal endoscopic discectomy (PTED) can obviously reduce the intraoperative soft tissue trauma. The aim of this study is to investigate the reactive pain in LDH patients undergoing PTED compared with open discectomy. Material and methods: This study retrospectively included 72 patients (PTED vs. open discectomy: 41 vs. 31), and the incidence of reactive pain, as well as both the extent and duration of reactive pain, were evaluated. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and after operation. Results: Significantly greater number of patients undergoing open discectomy showed reactive pain compared to those undergoing PTED (13/31, 41.9% vs. 7/41, 17.0%; P < 0.05), and the duration of reactive pain is mildly longer in the former (P < 0.05). In both patient groups, the patients with reactive pain showed increased IL-6 and IL-1β in drainage fluid, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and both duration and extent of reactive pain in both patient groups (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative reactive pain, and PTED may reduce this inflammatory accumulation at the surgical site and subsequently reduce the risk of reactive pain. Trial registration: This retrospective cohort analysis was retrospectively registered at September 9, 2020.