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Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation
Published on: April 14, 2023
Percutaneous endoscopic lumbar discectomy combined with sinuvertebral nerve ablation for lumbar disc herniation with
Study Design:
A retrospective case-control study.
Purpose:
This study aimed to evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with sinuvertebral nerve ablation (SNA) based on the clinical data of patients with lumbar disc herniation (LDH) accompanied by Modic type I changes (MC I).
Overview Of Literature:
Modic changes are associated with poorer outcomes following surgery. SNA effectively alleviates low back pain (LBP), and its analgesic effect is primarily mediated through neural ablation.
Methods:
Clinical data were collected from 136 patients with LDH and combined MC I who underwent PELD. They were divided into two groups based on treatment approaches: the PELD+SNA (PSNA) and PELD groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) score for back and leg pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI) for degenerative lumbar diseases at 1, 3, and 12 months postoperatively. The modified MacNab criteria were employed to evaluate efficacy at the final follow-up. Efficacy and adverse events were compared between the two groups.
Results:
No significant differences in sex, age, LDH segment, and location were observed between the two groups. In addition, no significant differences in the preoperative LBP VAS, leg pain VAS, lumbar JOA, or ODI were found between the two groups. The postoperative symptoms of patients in both groups were significantly relieved; specifically, the LBP and leg pain VAS scores, and the ODI, were significantly lower at all postoperative time points than preoperatively. A significant difference was observed between the PSNA and PELD groups. At the last follow-up, no significant difference in the modified MacNab score was observed between the two groups.
Conclusions:
SNA improved the efficacy of PELD for the treatment of LDH with MC I. The incorporation of SNA during surgery can lead to better long-term outcomes and reduced residual LBP after PELD.
