[Percutaneous endoscopic transforaminal discectomy for L5~S1 disc herniation]

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Orthopedic Surgery

Background:

• Lumbar disc herniation (LDH) at the L5-S1 level is a common cause of low back pain and disability.
• Traditional surgical approaches for L5-S1 LDH can involve significant tissue disruption.
• Percutaneous endoscopic techniques offer a less invasive alternative for spinal decompression.

Purpose of the Study:

• To evaluate the clinical outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for treating L5-S1 lumbar disc herniation (LDH).
• To assess the safety and efficacy of PETD, including its effectiveness in patients with anatomical variations like a high iliac crest.

Main Methods:

• A retrospective analysis of 102 patients who underwent PETD for L5-S1 LDH between April 2016 and June 2018.
• Inclusion of 13 patients with a high iliac crest, utilizing a "transverse process localization method" for surgical guidance.
• Pre- and postoperative pain was quantified using the Visual Analog Scale (VAS), and functional status was assessed with the Oswestry Disability Index (ODI).

Main Results:

• All operations were successful with no severe complications, including hemorrhages, infections, or nerve injuries.
• Significant improvements in VAS pain scores and ODI functional scores were observed postoperatively (P<0.01).
• High overall efficacy: 87.3% excellent, 7.8% good, 3.9% fair, and 1.0% poor outcomes. One patient (1.0%) experienced recurrence at 6 months.

Conclusions:

• Percutaneous endoscopic transforaminal discectomy (PETD) is a safe and effective surgical option for L5-S1 lumbar disc herniation (LDH).
• The "transverse process localization method" demonstrates potential efficacy in managing patients with challenging anatomy, such as high iliac crest or hypertrophic transverse processes.
• PETD offers a minimally invasive approach with favorable clinical results for L5-S1 LDH treatment.