A comparison of the transforaminal versus the interlaminar approach to percutaneous endoscopic surgeries in treating lumbar disc herniation

Objective To evaluate the indications and clinical results of percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) for the treatment of lumbar disc herniation (LDH). Methods A total of 126 patients of LDH were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Hospital and Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from April 2014 to June 2015. According to the surgical approach, the patients were divided into the PTED (66 cases) and PIED (60 cases) groups.Pre- and postoperative pain was assessed using the visual analog scale (VAS) and the patient’s functional status was evaluated using the Oswestry disability index (ODI). Various aspects were compared between the two groups that included operation time, times of intraoperative radioactive examinations, length of hospital stay, complications and postoperative recovery.The follow-up time is 3 to 23 months. Results In both groups, the patients' mean VAS scores and ODI were significantly decreased compared with data before operation(all P 0.05). The operation time(85.6±19.0 min) and frequencies of radiation exposure (28.1±10.3) in the PTED group were significantly higher than in the PIED group(operation time: 59.6±13.0 min, frequency of radiation exposure: 4.9±1.5); while the postoperative bedridden time(4.6±0.9 h) and complication rate (4.5%) in the PTED group were significantly lower than in the PIED group (bedridden time: 9.9±3.7 h, complication rate: 13.3%). Conclusions PTED and PIED are generally safe and efficacious in treatment of LDH.Selection of surgical approaches should be based on LDH types and locations. Key words: Intervertebral disc degeneration; Lumbar vertebrae; Diskectomy, percutaneous; Transforaminal; Interlaminar