Comparison study of the efficacy of spinal endoscopic decompression through 45° puncture versus traditional transforaminal endoscopic spinal system technique in the treatment of L5/S1 disc herniation
- VernacularTitle:经45°穿刺与传统经椎间孔内镜脊柱系统技术在脊柱内镜减压术治疗L5/S1椎间盘突出症中的应用效果比较
- Author:
Fei CAO
1
;
Peiheng YAO
1
;
Jinjun MIAO
1
;
Yaru JIAO
1
Author Information
- Publication Type:Journal Article
- Keywords: lumbar disc herniation(LDH); L5/S1 segment; spinal endoscopy; decompression; transforaminal endoscopic spinal system(TESSYS)technique; 45° puncture; transforaminal approach
- From: China Journal of Endoscopy 2025;31(4):65-73
- CountryChina
- Language:Chinese
- Abstract: Objective To investigate the efficacy and safety of spinal endoscopic decompression through 45° puncture foraminal approach in treatment of L5/S1 lumbar disc herniation(LDH).Methods Clinical data of 130 patients with L5/S1 level LDH from January 2021 to January 2023 were retrospectively analyzed.These patients were divided into two groups based on the spinal endoscopic surgery approach.Observation group(67 patients)underwent spinal endoscopic decompression via 45° puncture,while the control group(63 patients)underwent spinal endoscopic decompression using the traditional transforaminal endoscopic spinal system(TESSYS)technique.Perioperative indicators such as operation time,X-ray fluoroscopy time,and hospital stay were recorded for both groups.Visual analogue scale(VAS)scores for low back pain and lower limb pain,as well as the Oswestry disability index(ODI)were assessed before surgery and at 1 day,3 months,6 months,and 12 months after operation.The overall efficacy was evaluated using the modified MacNab criterion at 12 months postoperatively.Results All the patients in both groups successfully underwent spinal endoscopic decompression.The observation group had significantly shorter average operation time and intraoperative X-ray fluoroscopy time compared to the control group,the differences were statistically significant(P＜0.05).There was no significant difference in hospital stay between the two groups(P=0.505).Compared to preoperative values,both groups showed a significant decreasing trend in VAS scores for low back pain,lower limb pain,and ODI at 1 day,3 months,6 months,and 12 months after operation,the differences were statistically significant(P＜0.05).The observation group had significantly low back pain VAS score,lower limb pain VAS score and ODI at 1 day and 3 months after operation compared to the control group(P＜0.05).There were no statistically significant differences in low back pain VAS score,lower limb pain VAS score and ODI between the two groups 6 and 12 months after operation(P＞0.05).At 12 months after operation,the excellent and good rate was 95.5％ in observation group and 85.7％ in control group,with no significant difference between the two groups(P=0.054).No surgery-related complications occurred in either group.During postoperative follow-up,6 patients(9.5％)in control group experienced recurrence of low back pain and lower limb pain due to recompression of nerve roots by residual herniated material,while no recurrence was observed in observation group,the difference was statistically significant(P=0.035).Conclusion Both the 45° puncture technique and the traditional TESSYS technique can achieve satisfactory decompression effects in patients with LDH at the L5/S1 segment undergoing transforaminal spinal endoscopic decompression surgery.However,the 45° puncture technique can shorten the operation time and X-ray fluoroscopy time,resulting in more pronounced early postoperative improvement and a lower recurrence rate.It is worthy clinical application.
