RESUMEN
OBJECTIVE: This retrospective study evaluated the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH). METHODS: Data of 107 LDH patients admitted to the People's Hospital of Pingyang between July 2019 and May 2023 were analyzed retrospectively, including 51 cases treated with conventional open discectomy (control group) and 56 cases undergoing PTED (research group). We compared curative effects, operation time, intraoperative blood loss (IBL), incision length, time until ambulation, hospital stay, pre- and post-treatment pain intensity, lumbar function, and complications. Pain intensity was measured using the the Visual Analogue Scale (VAS), and the lumbar function was assessed by the Oswestry Disability Index (ODI). In addition, the factors influencing the efficacy in LDH patients were analyzed. RESULTS: The research group showed a statistically higher overall efficacy (P=0.034, χ2=4.479), longer operation time (P=0.002, t=3.114), less IBL (P<0.001, t=29.725), earlier ambulation (P<0.001, t=8.628), shorter hospital stay (P<0.001, t=8.628), and smaller incision length (P<0.001, t=15.948) than the control group. In addition, the postoperative VAS score (P<0.001, t=5.621) and ODI score (P<0.001, t=4.909) were reduced significantly after treatment and were lower in the research group than in the control group. The research group was also associated with a significantly lower overall complication rate (7.14% vs. 21.57%; P=0.032, χ2=4.608), including reduced incidence of lumbar spinal mobility limitation, incontinence, postoperative infection, and cauda equina syndrome. Furthermore, age, course of disease, and treatment method were strongly associated with the treatment efficacy in LDH patients. CONCLUSIONS: PTED is more effective than conventional open discectomy for LDH treatment. It reduces IBL, shortens incision length, facilitates patient recovery, alleviates postoperative pain, improves lumbar function, and minimizes the risk of postoperative complications.
RESUMEN
STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To investigate the correlation between lumbar disc herniation (LDH) and lumbar facet tropism (FT) on cephalad and caudad facet portions, respectively; to investigate the asymmetry between ipsilateral cephalad and caudad facet portions and its correlation with LDH. SUMMARY OF BACKGROUND DATA: There are still heavy debates on the exact correlation between lumbar FT and LDH. However, no study ever focused on the FT on different facet portions and asymmetry between ipsilateral cephalad and caudad portions in patients with LDH. METHODS: One hundred patients with L4/5 LDH, 100 patients with L5/S1 LDH, and 100 participants without LDH (control group) were age and sex matched and included in this study. Participants in each group were further divided into two subgroups based on age (≥ or < 50 yr old). Bilateral facet joint angles on both cephalad and caudad portions were measured. FT and asymmetry between ipsilateral cephalad and caudad portions in each LDH group were compared with those in corresponding control group. RESULTS: Comparing with control participants, the mean difference of bilateral facet angles in older patients with L4/5 LDH was significantly greater either on cephalad portion and caudad portion, whereas significantly higher frequency of FT was only exhibited on cephalad portion. In older patients with L4/5 LDH, the mean difference of facet angle between ipsilateral cephalad and caudad portions was significantly greater than that of control participants, the frequency of ipsilateral cephalad, and caudad facet asymmetry was also significantly higher. CONCLUSIONS: Only the FT on cephalad portion but not caudad portion of facet joint is associated with L4/5 LDH of older patients. The measurement on different portions of facet joint may result in discrepancy on FT identification. Asymmetry between ipsilateral cephalad and caudad facet portions is also associated with L4/5 LDH in older patients. LEVEL OF EVIDENCE: 3.