Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12928-12935
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12928
Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation
Zi-Han Zhang, Qian Du, Fu-Jun Wu, Wen-Bo Liao
Zi-Han Zhang, Fu-Jun Wu, Wen-Bo Liao, Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Qian Du, Department of Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Zhang ZH collected data and wrote and revised the manuscript; Liao WB designed the study; Du Q interpreted and analyzed the data; Wu FJ collected the data; and all authors approved the final version of the manuscript.
Supported by Science and Technology Support Plan of Guizhou Science and Technology Department, No. [2019]2812; and National Natural Science Foundation of China, No. 82060415.
Institutional review board statement: This study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the ethics committee of the Affiliated Hospital of Zunyi Medical University.
Informed consent statement: Written informed consent was obtained from all the patients.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: This is an open-access article that could be downloaded and shared provided that it is properly cited. This work cannot be changed in any way or used commercially without permission from the journal.
STROBE statement: The manuscript was revised according to the STROBE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bo Liao, MD, Chief Physician, Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563003, Guizhou Province, China. wenbo_liao@163.com
Received: October 18, 2022
Peer-review started: October 18, 2022
First decision: November 4, 2022
Revised: November 18, 2022
Accepted: November 24, 2022
Article in press: November 24, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

Disc herniation (DH) is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus. It is a common cause of lumbar and leg pains. Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis, imaging, and treatment of this condition. Total endoscopic discectomy is an alternative surgical technique that is less invasive.

AIM

To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.

METHODS

This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021. All patients were randomly divided into the following two groups: The observation group, comprising 62 patients who underwent surgery using the interlaminar approach, and the control group, comprising 58 patients who were operated through the foramina approach. The treatment effects, perioperative indicators, functional recovery, pain, and quality of life were compared between the two groups.

RESULTS

The treatment effect in the observation group (93.55%) was significantly better than that in the control group (77.59%). There was no difference in the operative time and intraoperative blood loss amount between the two groups (P > 0.05). The hospitalization time of the observation group (4.34 ± 1.33 d) was significantly shorter than that of the control group (5.38 ± 1.57 days) (P < 0.05). The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment, but the scores were lower in the observation group than in the control group. The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment, but scores were lower in the observation group (2.18 ± 0.88 in the lower back and 1.42 ± 0.50 in the leg) than in the control group (3.53 ± 0.50 in the lower back and 2.21 ± 0.52 in the leg). A short form of the Arthritis Impact Measurement Scales 2 measurement scale (AIMS2-SF) score and Barthel index of the lower back of the two groups increased significantly after treatment, with the observation group having a significantly higher AIMS2-SF score (95.16 ± 1.74) and Barthel index (97.29 ± 1.75) than the control group (84.95 ± 2.14 and 89.16 ± 2.71, respectively) (P < 0.05).

CONCLUSION

Through total endoscopic discectomy with the interlaminar approach, the degree of pain in the waist and leg was reduced, and the lumbar function considerably recovered.

Keywords: Disc herniation, Total endoscopic discectomy, Interlaminar approach, Transforaminal approach, Quality of life, Treatment effect

Core Tip: To study the optimal approach for a total endoscopic discectomy and its influence on leg and lumbar function in patients with disc herniation. Altogether, 120 patients with lumbar disc herniation were enrolled in this trial, including 62 patients who were operated through the interlaminar approach (observation group) and 58 who were operated through the foramina approach (control group). The therapeutic effect was evaluated according to various indicators, including the visual analog scale scores and Oswestry Disability Index. Our study showed that the treatment effect of total endoscopic discectomy using an interlaminar approach was remarkable.