Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the first 60 cases at the L4/5 level （Group I） and the first 60 cases at the L5/S1 level （Group II） of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C （Group I： A cases 1-20, B cases 21-40, C cases 41-60; Group I1： A cases 1-20, B cases 21-40, C cases 41-60）. Operation time was thoroughly analyzed. Results： Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were （88.75±17.02）, （67.75±6.16）, and （64.85±7.82） min, respectively. There was a significant difference between Groups A and B （P〈0.05）, but no significant difference between Groups B and C （P=-0.20）. The mean operation times of Groups IIA, liB, and IIC were （117.25±13.62）, （109.50±11.20）, and （92.15±11.94） rain, respectively. There was no significant difference between Groups A and B （P=0.06）, but there was a significant difference between Groups B and C （P〈0.05）. There were 6 cases of postoperative dysesthesia （POD） in Group I and 2 cases in Group IIA （P=-0.27）. There were 2 cases of residual disc in Group I, and 4 cases in Group II （P=0.67）. There were 3 cases of recurrence in Group I, and 2 cases in Group II （P〉0.05）. Conclusions： Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.

Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation

BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis,imaging,and treatment of this condition.Total endoscopic discectomy is an alternative surgical technique that is less invasive.AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021.All patients were randomly divided into the following two groups:The observation group,comprising 62 patients who underwent surgery using the interlaminar approach,and the control group,comprising 58 patients who were operated through the foramina approach.The treatment effects,perioperative indicators,functional recovery,pain,and quality of life were compared between the two groups.RESULTS The treatment effect in the observation group(93.55%)was significantly better than that in the control group(77.59%).There was no difference in the operative time and intraoperative blood loss amount between the two groups(P>0.05).The hospitalization time of the observation group(4.34±1.33 d)was significantly shorter than that of the control group(5.38±1.57 days)(P<0.05).The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment,but the scores were lower in the observation group than in the control group.The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment,but scores were lower in the observation group(2.18±0.88 in the lower back and 1.42±0.50 in the leg)than in the control group(3.53±0.50 in the lower back and 2.21±0.52 in the leg).A short form of the Arthritis Impact Measurement Scales 2 measurement scale(AIMS2-SF)score and Barthel index of the lower back of the two groups increased significantly after treatment,with the observation group having a significantly higher AIMS2-SF score(95.16±1.74)and Barthel index(97.29±1.75)than the control group(84.95±2.14 and 89.16±2.71,respectively)(P<0.05).CONCLUSION Through total endoscopic discectomy with the interlaminar approach,the degree of pain in the waist and leg was reduced,and the lumbar function considerably recovered.