Abstract: BACKGROUND: With the progress of minimally invasive procedures of the spine, endoscopic lumbar decompression has been widely used in the treatment of lumbar disc herniation. The indications of different endoscopic surgical approaches are different, and the decision of the specific operation plan needs to be combined with the actual situation and the choice of clinical surgeons.
OBJECTIVE: To investigate the short-term effect in treatment of single-level lumbar disc herniation by percutaneous endoscopic visual trephine arthroplasty.
METHODS: Ninety patients with single-level lumbar disc herniation admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 who met the inclusion criteria were included in this study. According to different approaches of percutaneous endoscopic visual trephine arthroplasty, they were divided into transforaminal approach group (control group, n=48 cases) and translaminar approach group (trial group, n=42 cases). The general information of patients in the two groups was recorded, including sex, age, disease course, body mass index, incision length, operation time, intraoperative fluoroscopy times, length of hospital stay, and amount of blood loss. Visual analog scale score of pain and Japanese Orthopaedic Association score at different follow-up stages were assessed. The modified MacNab standard was used to evaluate the clinical outcome at the last follow-up, and the postoperative complications and recurrence rate were measured.
RESULTS AND CONCLUSION: (1) The operation time and intraoperative fluoroscopy times of the trial group were less than those of the control group, and the difference was statistically significant (P < 0.05). However, there were no significant differences in intraoperative blood loss, incision length, and hospital stay between the two groups (P > 0.05). (2) There was no significant difference in visual analog scale score of pain and Japanese Orthopaedic Association score between the two groups before surgery (P > 0.05). However, visual analog scale of pain and Japanese Orthopaedic Association score were significantly improved 1 week, 3, 6, and 12 months after surgery (P < 0.05). (3) At the last follow-up, the good and good rate of modified MacNab standard was 94% in the control group and 95% in the trial group. (4) In the control group, one patient still felt back and leg pain after surgery, underwent open surgery, and recovered well after surgery without obvious sequelae. There were no postoperative complications or recurrent cases in the trial group. (5) It is concluded that both percutaneous transforaminal approach and interlaminar approach have good short-term clinical efficacy and high patient satisfaction in the treatment of single-level lumbar disc herniation, but the time of the interlaminar approach is shorter and has less intraoperative fluoroscopy times.

Key words: lumbar disc herniation, trephine arthroplasty, percutaneous transforaminal endoscopy, percutaneous transforaminal approach, percutaneous interlaminar approach