A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation
IntroductionThis study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy (PETD) in the surgical management of single-segment lumbar disc herniation (LDH) gluteal pain and to determine whether it provides a better clinical outcome than ope...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.930036/full |
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| author | Junyan An Jun Zhang Tong Yu Jiuping Wu Xinyu Nie Tao He Zhihe Yun Rui Liu Wu Xue Le Qi Yingzhi Li Qinyi Liu |
| author_facet | Junyan An Jun Zhang Tong Yu Jiuping Wu Xinyu Nie Tao He Zhihe Yun Rui Liu Wu Xue Le Qi Yingzhi Li Qinyi Liu |
| author_sort | Junyan An |
| collection | DOAJ |
| description | IntroductionThis study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy (PETD) in the surgical management of single-segment lumbar disc herniation (LDH) gluteal pain and to determine whether it provides a better clinical outcome than open lumbar discectomy (OD).MethodsA retrospective analysis of patients treated with modified PETD and OD for gluteal pain in LDH from January 2015 to December 2020 was conducted. Sample size was determined using a priori power analysis. Demographic information, surgical outcomes including procedure time (minutes), intraoperative blood loss (mL), hospital days, costs (RMB), fluoroscopy shots, recurrence and complications, etc., were recorded and analyzed. Prognostic outcomes were assessed using the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association Score (JOA) and modified MacNab criteria. The preoperative and postoperative VAS, ODI and JOA scores were recorded by two assistants. When the results were inconsistent, the scores were recorded again by the lead professor until all scores were consistently recorded in the data. MRI was used to assess radiological improvement and all patients received follow-ups for at least one year.ResultsThe sample size required for the study was calculated by a priori analysis, and a total of 72 participants were required for the study to achieve 95% statistical test power. A total of 93 patients were included, 47 of whom underwent modified PETD, and 46 of whom underwent OD. In the modified PETD intragroup comparison, VAS scores ranged from 7.14 ± 0.89 preoperatively to 2.00 ± 0.58, 2.68 ± 0.70, 2.55 ± 0.69, 2.23 ± 0.81, and 1.85 ± 0.72 at 7 days, 1 month, 3 months, 6 months, and 12 months postoperatively. Patients showed significant pain relief postoperatively (P < 0.01). According to the modified MacNab score, the excellent rate in the PETD group was 89.36%. There was no significant difference compared to the OD group (89.13%, P > 0.05). Complication rates were lower (P > 0.05) but recurrence rates were higher (P > 0.05) in the modified PETD group than in the OD group. The modified PETD group had a faster operative time (P < 0.01), shorter hospital stay (P < 0.01), less intraoperative bleeding (P < 0.01), and less financial burden to the patient (P < 0.01) than the OD group. At 7 days postoperatively, the VAS score for low back pain was higher in the OD group than in the modified PETD group (P < 0.01). The VAS and JOA scores at 1, 3, 6, and 12 months postoperatively were not significantly different between the modified PETD and OD groups (P > 0.05), and the ODI was significantly different at 3 months postoperatively (P < 0.05).ConclusionModified PETD treatment is safe and effective for gluteal pain due to L4/5 disc herniation and has the advantages of a lower complication rate, faster postoperative recovery, shorter length of stay, fewer anesthesia risks and lower cost of the procedure compared with OD. However, modified PETD has a higher recurrence rate. |
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| last_indexed | 2024-12-12T06:17:28Z |
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| series | Frontiers in Surgery |
| spelling | doaj.art-7ccb1e12f4654f388f971869e3ae883d2022-12-22T00:34:59ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-06-01910.3389/fsurg.2022.930036930036A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc HerniationJunyan An0Jun Zhang1Tong Yu2Jiuping Wu3Xinyu Nie4Tao He5Zhihe Yun6Rui Liu7Wu Xue8Le Qi9Yingzhi Li10Qinyi Liu11epartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, Chinaepartment of Orthopedics, The Second Hospital of Jilin University, Changchun, ChinaIntroductionThis study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy (PETD) in the surgical management of single-segment lumbar disc herniation (LDH) gluteal pain and to determine whether it provides a better clinical outcome than open lumbar discectomy (OD).MethodsA retrospective analysis of patients treated with modified PETD and OD for gluteal pain in LDH from January 2015 to December 2020 was conducted. Sample size was determined using a priori power analysis. Demographic information, surgical outcomes including procedure time (minutes), intraoperative blood loss (mL), hospital days, costs (RMB), fluoroscopy shots, recurrence and complications, etc., were recorded and analyzed. Prognostic outcomes were assessed using the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association Score (JOA) and modified MacNab criteria. The preoperative and postoperative VAS, ODI and JOA scores were recorded by two assistants. When the results were inconsistent, the scores were recorded again by the lead professor until all scores were consistently recorded in the data. MRI was used to assess radiological improvement and all patients received follow-ups for at least one year.ResultsThe sample size required for the study was calculated by a priori analysis, and a total of 72 participants were required for the study to achieve 95% statistical test power. A total of 93 patients were included, 47 of whom underwent modified PETD, and 46 of whom underwent OD. In the modified PETD intragroup comparison, VAS scores ranged from 7.14 ± 0.89 preoperatively to 2.00 ± 0.58, 2.68 ± 0.70, 2.55 ± 0.69, 2.23 ± 0.81, and 1.85 ± 0.72 at 7 days, 1 month, 3 months, 6 months, and 12 months postoperatively. Patients showed significant pain relief postoperatively (P < 0.01). According to the modified MacNab score, the excellent rate in the PETD group was 89.36%. There was no significant difference compared to the OD group (89.13%, P > 0.05). Complication rates were lower (P > 0.05) but recurrence rates were higher (P > 0.05) in the modified PETD group than in the OD group. The modified PETD group had a faster operative time (P < 0.01), shorter hospital stay (P < 0.01), less intraoperative bleeding (P < 0.01), and less financial burden to the patient (P < 0.01) than the OD group. At 7 days postoperatively, the VAS score for low back pain was higher in the OD group than in the modified PETD group (P < 0.01). The VAS and JOA scores at 1, 3, 6, and 12 months postoperatively were not significantly different between the modified PETD and OD groups (P > 0.05), and the ODI was significantly different at 3 months postoperatively (P < 0.05).ConclusionModified PETD treatment is safe and effective for gluteal pain due to L4/5 disc herniation and has the advantages of a lower complication rate, faster postoperative recovery, shorter length of stay, fewer anesthesia risks and lower cost of the procedure compared with OD. However, modified PETD has a higher recurrence rate.https://www.frontiersin.org/articles/10.3389/fsurg.2022.930036/fulllumbar disc herniationgluteal painpercutaneous endoscopic transforaminal discectomyopen lumbar discectomyminimally invasive surgery |
| spellingShingle | Junyan An Jun Zhang Tong Yu Jiuping Wu Xinyu Nie Tao He Zhihe Yun Rui Liu Wu Xue Le Qi Yingzhi Li Qinyi Liu A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation Frontiers in Surgery lumbar disc herniation gluteal pain percutaneous endoscopic transforaminal discectomy open lumbar discectomy minimally invasive surgery |
| title | A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation |
| title_full | A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation |
| title_fullStr | A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation |
| title_full_unstemmed | A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation |
| title_short | A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation |
| title_sort | retrospective comparative study of modified percutaneous endoscopic transforaminal discectomy and open lumbar discectomy for gluteal pain caused by lumbar disc herniation |
| topic | lumbar disc herniation gluteal pain percutaneous endoscopic transforaminal discectomy open lumbar discectomy minimally invasive surgery |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.930036/full |
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