EVALUATION OF THE EFFECTIVENESS OF UNILATERAL BIPORTAL ENDOSCOPIC DISCECTOMY IN COMPARISON WITH INTERLAMINAR MICRODISCECTOMY IN THE TREATMENT OF HERNIATED INTERVERTEBRAL DISCS OF THE LUMBAR SPINE

Abstract

The aim of the study is to conduct a comparative analysis of the effectiveness of the methods of unilateral biportal endoscopic discectomy and interlaminar microdiscectomy among patients operated on for herniated intervertebral discs of the lumbar spine. Materials and methods. The study was conducted at the Department of spine and spinal cord neurosurgery of the Regional Clinical Hospital of the Ivano-Frankivsk from May 2021 to August 2022. The sample consisted of 99 patients with intervertebral disc herniation (at the level of L2-L3, L3-L4, L4-L5, L5-S1), including 44 men and 57 women. Criteria for intergroup distribution: group 1 (n = 43) – removal of the intervertebral disc herniation was performed by the method of unilateral biportal endoscopic discectomy; group 2 (n = 56) – interlaminar microdiscectomy was performed. Examination methods - VAS (cm), Oswestry questionnaire after 1 month, 6 and 12 months, respectively. Statistical processing of the results was carried out using Microsoft Excel and Statistica 8.0 (StatSoft Inc.). Results. In the preoperative period, the back pain index was 6,9±1,1 and 6,7±1,4 in groups 1 and 2, respectively. In the postoperative period in group 1, the back pain index according to VAS decreased from 6,9±1,1 cm to 1,9±0,5 cm the next day, with positive dynamics remaining during the year of observation of 0,2±0,2 cm, respectively. In group 2, at the time of discharge, the pain index was noted at the level of 3,5 ± 0,9 cm with a gradual improvement to 0,7 ± 0,5 cm. Assessment of the severity of radicular pain in the leg in the postoperative period after 1 month showed a significant improvement in both groups: in group 1 from 7,2±0,6 cm to 0,5±0,5 and in group 2 from 7,8±0,5 cm to 0,5±0,3 cm. Significant differences between observation groups during the last survey was not detected. The duration of the operation when using endoscopic access was lower than during microdiscectomy (35,7±15,2 min (M±SD)) and (45,8±13,7 min (M±SD)), respectively (р≤0, 05). The amount of blood loss was 3,8 times less determined during endoscopic access ((35,4±18,9 ml (M±SD)) and (122,2±90,9 ml (M±SD)), respectively (р≤0,05). The length of stay in the hospital was shorter in the endoscopic discectomy group. Conclusions. The method of unilateral biportal endoscopic microdiscectomy, due to its low trauma, allows the patient to return to an active lifestyle more quickly compared to open microdiscectomy. No significant differences were found according to VAS and Oswestry indicators at the remote stage of observation.

Keywords

• biportal endoscopic discectomy
• interlaminar microdiscectomy
• rehabilitation
• recovery