Comparison of the therapeutic effects of different approaches of spinal endoscopy in the treatment of L4/5 segment prolapse type lumbar disc herniation
- VernacularTitle:不同入路脊柱内镜手术治疗L4/5节段脱垂型腰椎间盘突出症的疗效比较
- Author:
Xiang CHEN
1
;
Haiyu MA
1
;
Shengli MA
1
Author Information
- Publication Type:Journal Article
- Keywords: lumbar disc herniation(LDH); prolapse type; spinal endoscopy; intervertebral approach; intervertebral foramen approach
- From: China Journal of Endoscopy 2025;31(7):76-85
- CountryChina
- Language:Chinese
- Abstract: Objective To observe the surgical outcomes and complications of transforaminal endoscopic lumbar discectomy(TELD)and interlaminar endoscopic lumbar discectomy(IELD)in the treatment of lumbar disc herniation(LDH)with prolapse type at the L4/5 segment using full-endoscopic spine surgery.Methods A retrospective analysis was conducted on the clinical data of 75 patients with L4/5 segmental prolapse type LDH who underwent spinal endoscopic surgery from November 2020 to November 2022.Among them,53 patients underwent TELD(TELD group)and 22 patients underwent IELD(IELD group).The surgical outcomes and postoperative therapeutic effect of the two groups were compared.Results Compared with the TELD group,the IELD group had significantly shorter operation time and fewer intraoperative fluoroscopy times,the differences were statistically significant(P<0.05);There were no statistically significant in the length of hospital stay and the incidence of complications between the two groups(P>0.05).All patients were followed up for 12 to 19 months after surgery.The visual analogue scale(VAS)score and Oswestry disability index(ODI)at the last follow-up in both groups were significantly lower than those before surgery,and the IELD group was significantly lower than the TELD group,the differences were statistically significant(P<0.05).Further analysis based on the location of the herniation and nerve roots revealed that,compared with preoperative values,the VAS scores and ODI at the last follow-up were significantly reduced in both groups of patients with shoulder-upper type herniation(10 cases in the TELD group and 6 cases in the IELD group),and the VAS score in the IELD group at the last follow-up was significantly lower than that in the TELD group,the differences were statistically significant(P<0.05).Similarly,both groups of patients with axillary type herniation(8 cases in the TELD group and 16 cases in the IELD group)exhibited significantly reduced VAS score and ODI at the last follow-up than those before operation,with significantly lower in the IELD group compared to the TELD group,the differences were statistically significant(P<0.05).Among the 35 patients with anterior-shoulder type herniation who underwent TELD,the VAS score and ODI at the last follow-up were also significantly lower than those before surgery,the difference was statistically significant(P<0.05).Further analysis based on the Lee classification of herniations revealed that,compared with preoperative values,the VAS score and ODI at the last follow-up were significantly reduced in both groups of patients with herniations in Lee zone Ⅲ(44 cases in the TELD group and 10 cases in the IELD group),and the ODI in the IELD group was significantly lower than that in the TELD group,the differences were statistically significant(P<0.05).Similarly,both groups of patients with LDH in Lee zone Ⅳ(9 cases in the TELD group and 12 cases in the IELD group)exhibited significantly reduced VAS score and ODI at the last follow-up,with significantly lower in the IELD group compared to the TELD group(P<0.05).Conclusion Both TELD and IELD can achieve satisfactory decompression effects in the treatment of LDH with prolapse type at the L4/5 segment.However,IELD offers a relatively shorter operative time,requires fewer X-ray fluoroscopies,and demonstrates superior decompression effects for shoulder-type,axillary-type,Lee Ⅲ and Lee Ⅳ.
