Advertisement

Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study

  • Kang Li
  • Kai Gao
  • Tao Zhang
  • Chao-liang LvEmail author
Original Article

Abstract

Purpose

In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms.

Methods

A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups.

Results

The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05).

Conclusion

For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Percutaneous endoscopic lumbar discectomy Unilateral transforaminal approach Lumbar disc herniation Bilateral symptoms 

Notes

Acknowledgements

This study was supported by Shandong Science and Technology Development Plan on Medicine and Hygiene in China (Grant Number: 2017WS519). This study was also supported by Jining Science and Technology Boosting New and Old Energy Conversion Plan in China (Grant Number: 2017SMNS010).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6210_MOESM1_ESM.pptx (11.6 mb)
Supplementary material 1 (PPTX 11927 kb)
586_2019_6210_MOESM2_ESM.tif (936 kb)
Supplemental Fig. 1A schematic drawing showing PELD through unilateral interlaminar approach for L5/S1 LDH with bilateral symptoms. Due to limitation of vertebral plate and facet joint, the traction of dura sac during contralateral discectomy is severe. (TIFF 935 kb)
586_2019_6210_MOESM3_ESM.tif (484 kb)
Supplemental Fig. 2A schematic drawing showing PELD through unilateral transforaminal approach for L5/S1 LDH with bilateral symptoms. Due to the limitation of iliac crest, the angle from working cannula to disc plane is too great for working cannula to be inserted parallel with disc plane, which limits the exposure of contralateral spinal canal and remove contralateral herniated disc. The blue zone shows ipsilateral herniated disc and the red zone shows contralateral herniated disc. (TIFF 483 kb)

References

  1. 1.
    Yeung AT, Yeung CA (2007) Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am 38 (3):363–372; abstract vi.  https://doi.org/10.1016/j.ocl.2007.04.005 CrossRefGoogle Scholar
  2. 2.
    Tsou PM, Alan Yeung C, Yeung AT (2004) Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J 4(5):564–573.  https://doi.org/10.1016/j.spinee.2004.01.014 CrossRefPubMedGoogle Scholar
  3. 3.
    Tsou PM, Yeung AT (2002) Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J 2(1):41–48CrossRefGoogle Scholar
  4. 4.
    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731CrossRefGoogle Scholar
  5. 5.
    Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29(16):E326–332CrossRefGoogle Scholar
  6. 6.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33(9):931–939.  https://doi.org/10.1097/BRS.0b013e31816c8af7 CrossRefPubMedGoogle Scholar
  7. 7.
    Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS (2008) Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 33(15):E508–515.  https://doi.org/10.1097/BRS.0b013e31817bfa1a CrossRefPubMedGoogle Scholar
  8. 8.
    Ahn Y, Jang IT, Kim WK (2016) Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 147:11–17.  https://doi.org/10.1016/j.clineuro.2016.05.016 CrossRefPubMedGoogle Scholar
  9. 9.
    Kim HS, Paudel B, Jang JS, Lee K, Oh SH, Jang IT (2018) Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations (LDH) including severely difficult and extremely difficult LDH cases. Pain Physician 21(4):E401–E408PubMedGoogle Scholar
  10. 10.
    Ren C, Li Y, Qin R, Sun P, Wang P (2017) Transforaminal endoscopic lumbar discectomy for lumbar disc herniation causing bilateral symptoms. World Neurosurg 106:413–421.  https://doi.org/10.1016/j.wneu.2017.06.191 CrossRefPubMedGoogle Scholar
  11. 11.
    Gu J, Guan F, Zhu L, Guan G, Chi Z, Wang H, Yu Z (2016) Risk factors of postoperative low back pain for lumbar spine disease. World Neurosurg 94:248–254.  https://doi.org/10.1016/j.wneu.2016.07.010 CrossRefPubMedGoogle Scholar
  12. 12.
    Choi SH, Adsul NM, Kim HS, Kim KJ, Kim JH, Chung SK, Choi JH, Jang JS, Jang IT, Oh SH (2018) Percutaneous endoscopic interlaminar unilateral ventral dural approach for symptomatic bilateral L5-S1 herniated nucleus pulposus: technical note. J Neurol Surg Part A Cent Eur Neurosurg 79(6):518–523.  https://doi.org/10.1055/s-0038-1639505 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Spine SurgeryJining No. 1 People’s HospitalJiningPeople’s Republic of China
  2. 2.Department of Spine SurgeryAffiliated Jining No. 1 People’s Hospital of Jining Medical University, Jining Medical UniversityJiningPeople’s Republic of China
  3. 3.Department of Joint SurgeryJining No. 1 People’s HospitalJiningPeople’s Republic of China

Personalised recommendations