Percutaneous endoscopic lumbar discectomy for the treatment of high iliac crest L5/S1 disc herniation

doi:10.12307/2021.192

Abstract

Abstract: BACKGROUND: In clinic, percutaneous endoscopy is applied more and more in the treatment of lumbar disc herniation. However, in the case of high iliac L5/S1 disc herniation, difficulty and uncertainty of the operation increase as the obstruction of the high iliac crest.
OBJECTIVE: To summarize and analyze indications, advantages and disadvantages of lateral transforaminal percutaneous endoscopy and posterior interlaminar percutaneous endoscopy for treatment of high iliac crest L5/S1 disc herniation.
METHODS: Medical records were retrospectively analyzed in 99 patients undergoing discectomy by percutaneous endoscopy. There were 31 high iliac crest L5/S1 disc herniation cases treated by lateral transforaminal percutaneous endoscopy (group A), and 33 high iliac crest L5/S1 disc herniation cases treated by posterior interlaminar percutaneous endoscopy (group B), and 35 normal iliac L5/S1 disc herniation cases treated by lateral transforaminal percutaneous endoscopy (group C). Operation time, times of X-ray fluoroscopy, complications during operation and after operation were recorded. Visual analogue scale scores of the patients in pre-operation, 1-day post-operation, 3-month post-operation, 2-year post-operation were applied to evaluate severity of the lower limb pain. Oswestry disability index was applied to evaluate the lumbar function of the patients. Macnab criteria were used to evaluate the clinical efficacy at 2 years follow-up.
RESULTS AND CONCLUSION: (1) The operation time of group A and group C was significantly longer than that of group B (P < 0.05), but there was no significant difference between group A and group C (P > 0.05). (2) Times of X-ray fluoroscopy of group A and group C were significantly more than those of group B (P < 0.05); the times of X-ray fluoroscopy of group A were more than those of group C, but the difference was not significant (P > 0.05). (3) Visual analogue scale scores and Oswestry disability index of lower limb pain at each time point after operation in each group were significantly lower than those before operation (P < 0.05). There was no significant difference among the three groups (P > 0.05). (4) According to MacNab standard, the excellent and good rate of groups A, B and C was 97% at 2 years follow-up. (5) Results suggest that for patients with high iliac crest L5/S1 disc herniation, operation time and times of X-ray fluoroscopy of lateral transforaminal percutaneous endoscopy were more than posterior interlaminar percutaneous endoscopy. Operation time and times of X-ray fluoroscopy of lateral transforaminal percutaneous endoscopy in the treatment of high iliac crest L5/S1 disc herniation were more than the normal iliac crest L5/S1 disc, but the difference was not significant. For the treatment of high iliac crest L5/S1 disc herniation, posterior interlaminar percutaneous endoscopy was superior to lateral transforaminal percutaneous endoscopy in a certain sense, but in practice, we should consider the position of the herniation at the same time.

Key words: lumbar intervertebral disc herniation, mini-invasive, endoscopy, high-iliac crest, lateral approach, posterior interlaminar approach

CLC Number:

Cui Guanyu, Shu Xiong, Liu Yajun, Sun Yuqing, He Da, Liu Bo, Tian Wei. Percutaneous endoscopic lumbar discectomy for the treatment of high iliac crest L5/S1 disc herniation[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4333-4338.

Figures/Tables 3

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