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Der Orthopäde

, Volume 48, Issue 2, pp 157–164 | Cite as

Percutaneous endoscopic lumbar discectomy and microsurgical laminotomy

A prospective, randomized controlled trial of patients with lumbar disc herniation and lateral recess stenosis
  • Lei Kong
  • Xi-Fu Shang
  • Wen-Zhi Zhang
  • Li-Qun Duan
  • Yang Yu
  • Wei-Jian Ni
  • Yan HuangEmail author
Originalien

Abstract

Background

Sufficient decompression of the nerve root canal is still regarded as the method of choice when operating on patients with lumbar disc herniation (LDH) with lumbar lateral recess stenosis; however, tissue-sparing procedures are becoming more popular. Endoscopic techniques offer advantages and the benefits of rehabilitation, which have become the standard in many surgical operations when operating on the spine. A significant issue has been the upgrading of instruments to provide enough bone resection under continuous visual control.

Material and methods

We examined patients who had LDH with lateral recess stenosis and compared the results of nerve root canal decompression using percutaneous endoscopic lumbar discectomy (PELD) with a microsurgical laminotomy (ML) technique. In this study 40 patients with full endoscopic decompression or microsurgery were followed up for 2 years. In addition to general and specific parameters, the following two parameters were also used for the investigation: the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).

Results

Except for 1 patient in whom repair was done by fusion and 1 who was lost to follow-up, 38 patients remained in the study over the 2 years. The mean operating time in the PELD group was longer (p < 0.05), but intraoperative and postoperative blood loss was less than in the ML group (p < 0.05). The postoperative results were better than before surgery, and the VAS and ODI parameters indicated a clear improvement in leg pain and daily activities in both groups (p > 0.05). Of the patients three suffered increasing back pain (2 ML, 1 PELD).

Conclusion

The results indicated that the PELD can provide an effective supplement and serve as an alternative for LDH with lateral recess stenosis compared with the ML technique when the indication criteria are fulfilled. The PELD also has the advantage of being a minimally invasive intervention.

Keywords

Root canal Visual analog scale Intervertebral disc diseases Lumbar vertebrae Postoperative blood loss 

Abbreviations

LDH

Lumbar disc herniation

MISTLIF

Minimally invasive surgery transforaminal lumbar interbody fusion

ML

Microsurgical laminotomy

MRI

Magnetic resonance imaging

NSAID

Non-steroidal anti-inflammatory drugs

ODI

Oswestry disability index

PELD

Percutaneous endoscopic lumbar discectomy

TLIF

Transforaminal lumbar interbody fusion

VAS

Visual analog scale

Perkutane endoskopische lumbale Diskektomie und mikrochirurgische Laminotomie

Eine prospektive, randomisierte, kontrollierte Studie zu Patienten mit Bandscheibenvorfall der Lendenwirbelsäule und lateraler Rezessusstenose

Zusammenfassung

Hintergrund

Die ausreichende Dekompression des Nervenwurzelkanals wird bei der Operation von Patienten mit einem Bandscheibenvorfall an der Lendenwirbelsäule (LDH) mit lumbaler lateraler Rezessusstenose nach wie vor als Methode der Wahl angesehen, jedoch werden gewebeerhaltende Verfahren immer beliebter. Endoskopische Verfahren, die bei vielen chirurgischen Eingriffen an der Wirbelsäule Standard sind, bieten Vorteile und eine bessere Rehabilitation. Ein signifikantes Problem war das Upgrading der Instrumente, um unter kontinuierlicher visueller Kontrolle ausreichend Knochenresektion zu gewährleisten.

Material und Methoden

Patienten mit einem Bandscheibenvorfall an der Lendenwirbelsäule mit lateraler Rezessusstenose wurden untersucht und die Ergebnisse der Nervenwurzelkanaldekompression mittels perkutaner endoskopischer lumbaler Diskektomie (PELD) mit einer mikrochirurgischen Laminotomie (ML) verglichen. In dieser Studie wurden 40 Patienten mit einer vollständigen endoskopischen Dekompression oder Mikrochirurgie für 2 Jahre nachbeobachtet. Zusätzlich zu den allgemeinen und spezifischen Parametern wurden noch die 2 folgenden Parameter für die Untersuchung verwendet: die visuelle Analogskala (VAS) und der Oswestry Disability Index (ODI).

Ergebnisse

Außer einem Patienten, der mittels Fusion behandelt wurde, und einem Patienten, der für die Nachbeobachtung nicht mehr zur Verfügung stand („lost to follow up“), blieben 38 Patienten für 2 Jahre in der Studie. Die mittlere Operationszeit in der PELD-Gruppe war länger (p < 0,05), aber der intraoperative und postoperative Blutverlust waren geringer als in der ML-Gruppe (p < 0,05). Die postoperativen Ergebnisse waren besser als vor dem Eingriff, und die Parameter von VAS und ODI zeigten eine deutliche Verbesserung der Beinschmerzen sowie der täglichen Aktivitäten in beiden Gruppen (p > 0,05). Drei Patienten hatten zunehmende Rückenschmerzen (2 ML, 1 PELD).

Schlussfolgerung

Die Ergebnisse zeigten, dass die PELD eine effektive Ergänzung sein kann und eine Alternative für LDH mit lateraler Rezessusstenose darstellt im Vergleich zur ML-Technik, sofern die Indikationskriterien erfüllt sind. Vorteil der PELD ist auch, dass es sich dabei um ein minimal-invasives Verfahren handelt.

Schlüsselwörter

Wurzelkanal Visuelle Analogskala Erkrankungen der Bandscheiben Lendenwirbel Postoperativer Blutverlust 

Notes

Compliance with ethical guidelines

Conflict of interest

L. Kong, X.-F. Shang, W.-Z. Zhang, L.-Q. Duan, Y. Yu, W.-J. Ni and Y. Huang declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Lei Kong
    • 1
  • Xi-Fu Shang
    • 1
  • Wen-Zhi Zhang
    • 1
  • Li-Qun Duan
    • 1
  • Yang Yu
    • 1
  • Wei-Jian Ni
    • 2
  • Yan Huang
    • 1
    Email author
  1. 1.Department of OrthopedicAnhui Provincial HospitalHefeiChina
  2. 2.Department of PharmacyAnhui Provincial HospitalHefeiChina

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