OBJECTIVETo evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH).

METHODSFrom August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed.

RESULTSAll patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01).

CONCLUSIONSCompared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.