Comparison study between intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L₅/S₁ disc herniation

ObjectiveTo investigate the clinical effects between intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L₅/S₁ disc herniation.

MethodsForty-three patients with L₅/S₁ disc herniation were divided into the intervertebral foramen approach group (n=21) and interlaminar approach group (n=22).The clinical efficacy was assessed using Visual Analog Scale (VAS) and modified MacNab evaluation criteria.The operation time, postoperative ambulation time, postoperative hospitalization time, in-patient cost and postoperative complication were compared between two groups.

ResultsAll opereations were successful.The patients were followed up for mone than 6 months.The bed time, postoperative hospitalization time, total hospitalization expense in intervertebral foramen approach group were lower than those in interlaminar approach group (P < 0.01).The VAS scores of back and leg in two groups after 1 month, 3 months and 6 months of operation were significantly lower than those before operation (P < 0.05).The differences of the operation time and VAS scores of back and leg in two groups between before and after operation were not statistically significant (P>0.05).The excellent in 14 cases, good in 4 cases, fair in 3 cases and poor in 0 case in intervertebral foramen approach group, and excellent in 13 cases, good in 5 cases, fair in 4 cases and poor in 0 case in interlaminar approach group were identified using improved MacNab scale, respectively, and the difference of which between two groups was not statistically significant (P>0.05).No severe complication in two groups was found after operation.

ConclusionsThe intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L₅/S₁ disc herniation are safe and effective.Compared with the interlaminar approach, the intervertebral foramen approach has little invasion, quick recovery and few contraindications, which is more suitable to the concept of minimally invasive surgery.