Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery

Background:

• Two-level lumbar disc herniation (LDH) at L4/5 and L5/S1 presents complex surgical challenges.
• Percutaneous endoscopic lumbar discectomy (PELD) offers a minimally invasive approach for LDH.
• Combining different PELD approaches may optimize outcomes for multi-level pathologies.

Purpose of the Study:

• To evaluate a novel surgical strategy combining percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID).
• To assess the safety and efficacy of this combined approach for treating L4/5 and L5/S1 two-level disc herniation.

Main Methods:

• Retrospective study of 19 patients with L4/5 and L5/S1 two-level LDH.
• PETD used for L4/5 herniation, PEID for L5/S1 herniation, performed by an experienced surgeon.
• Outcomes assessed using Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for function, and modified MacNab criteria, with MRI for radiographic evaluation.

Main Results:

• Successful PELD procedures with satisfactory outcomes in all patients.
• Significant reductions in VAS-Back (5.58 to 2.37) and VAS-Leg (7.00 to 1.63) scores (P < 0.05).
• Significant improvement in ODI scores (44.84% to 11.12%) (P < 0.05), with 89.47% achieving excellent or good recovery.
• Low complication rate: two cases of transient dysesthesia and one small dural tear, both resolved without long-term sequelae.

Conclusions:

• Combined PETD and PEID is a safe and effective technique for managing L4/5 and L5/S1 two-level disc herniation.
• This minimally invasive strategy leads to significant pain relief and functional improvement.
• The combined approach offers a viable alternative for complex multi-level lumbar disc herniation.