Analysis of clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy for lumbar herniated disk.

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Analysis of clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy for lumbar herniated disk.

World Neurosurg. 2017 Apr 10;:

Authors: Kim HS, Yudoyono F, Paudel B, Jang JS, Choi JH, Chung SK, Kim JH, Jang IT, Oh SH, Park JE, Lee S

Abstract
OBJECTIVE: Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) can be performed by using foraminal, intervertebral and suprapedicular routes. The aim of this study was to assess clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy (PETLD).
METHODS: 111 patients who had undergone PETLD between January 2016 and October 2016 were included in this study. PETLD was performed by using the foraminal (group A), intervertebral (group B), and suprapedicular (group C) routes in 32, 46, and 33 patients, respectively. Outcomes were evaluated by using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria.
RESULTS: 71 were men and 40 were women (mean age 53.33±14.12 years). The mean follow-up period was 6.44±3.26 months. The preoperative VAS score decreased significantly (p<0.01) in all 3 groups. But the postoperative VAS score was higher for the foraminal route than for the intervertebral (p=0.001) and suprapedicular routes (p<0.001). Excellent outcome grade according to MacNab criteria was less in foraminal route (18.7%) than in intervertebral (52.2%) and suprapedicular (56.7%) routes. ODI improved significantly (p<0.01) in all 3 groups.
CONCLUSION: All 3 routes of PETLD resulted in good to excellent clinical results. Nevertheless, the postoperative VAS score was higher for the foraminal route than for the intervertebral and suprapedicular routes, probably not because of the surgery but because of the neurological characteristics of the disk location. The surgeon should consider this problem to alleviate pain postoperatively and counsel to patient well before surgery.

PMID: 28408266 [PubMed - as supplied by publisher]

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