Safety and efficacy of 5.3 mm intervertebral endoscopy in minimally invasive technique for lumbar disc herniation

Objective To study the application value of nerve root decompression through posterior approach in minimally invasive surgery of lumbar disc herniation (LDH). Methods From June 2016 to June 2018, 80 patients with unilateral single segment LDH were selected and diagnosed in Yunnan Puer People′s Hospital.The patients were divided into control group and observation group according to the random number table method, 40 cases in each group.The control group was treated with posterior fenestration and nucleus pulposus extraction, and the observation group was treated with posterior neurolysis and decompression through 5.3 mm intervertebral foramen.The incision length, operation time, intraoperative blood loss and postoperative hospital stay were compared between the two groups.The visual analog scale (VAS) of pain before operation and 1, 2, 7 days after operation was compared.The Japanese Orthopedic Association (JOA) score and the Oswestry disability index (ODI) questionnaire score before operation and 1, 3, 12 months after operation were compared.The effect of lumbar function recovery 12 months after operation was compared. Results The incision length, operation time, days in-hospital after operation, and bleeding amount in observation group were (0.9±0.2) cm, (50.8±8.6) min, (16.5±5.9) ml, (4.3±0.5)d, and in control group were (4.6±0.8) cm, (72.3±15.2) min, (52.5±10.3) ml, (7.2±0.9)d.The differences between the two groups were statistically significant (t=8.625, 14.623, 32.625, 6.524, all P<0.001). The VAS scores of the observation group and the control group were (5.7±1.1), (3.3±0.6), (1.2±0.3), (0.5±0.1) and (5.5±1.2), (4.2±0.8), (1.9±0.4), (1.1±0.3) before and 1, 3 and 7 days after the operation, respectively.The differences 1, 3, 7 days after operation between the observation group and the control group were statistically significant (all P<0.05). The JOA scores of the observation group were (8.1±1.6), (19.3±4.2), (23.2±4.9), (25.8±5.2) before and 1, 3 and 12 months after operation, respectively, and those of the control group were (8.3±1.5), (15.2±3.3), (19.3±4.2), (20.6±5.5) after operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The ODI scores of the observation group were (43.7±10.6), (18.3±5.2), (10.2±3.9), (1.8±0.5) before and 1, 3 and 12 months after the operation, respectively, and those of the control group were (42.5±9.4), (25.2±5.3), (14.3±4.2), (4.6±0.9) after the operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The effective rate of the observation group was significantly higher than that of the control group (92.5%(30/40) vs.75.0%(37/40), χ2=4.501, all P=0.034). Conclusion It can bring less trauma and faster recovery with 5.3mm intervertebral endoscopy by posterior approach of nerve root decompression for LDH patients, which is better safety and efficacy. Key words: Intervertebral endoscopy; Nerve root decompression; Lumbar disc herniation; Lumbar function