A one-step foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation.

Abstract

BackgroundTransforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time.Methods70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group.ResultsThe operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P 0.05).ConclusionsThe one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.