Percutaneous endoscopic lumbar discectomy in treatment of lumbar disc herniation: a long-term follow-up study

Abstract

Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation. Methods Patients who received single-level percutaneous endoscopic lumbar discectomy for lumbar disc herniation in our department from January 2012 to December 2015 were recruited and followed up for at least 5 years. Oswestry disability index (ODI) and visual analogue scale (VAS) scores of waist and leg were evaluated preoperatively, 3, 6 and 12 months postoperatively, and at the last follow-up. Postoperative complications and their treatment were recorded and analyzed. Results A total of 1 807 cases were included, of which, 1 706 cases were followed up and 101 cases were lost to follow-up, with a follow-up rate of 94.08%. The mean follow-up time was 6.36±1.08 years. The ODI scores at 3, 6 and 12 months postoperatively and last follow-up were 26.01±7.48, 20.87±7.50, 17.25±7.77 and 17.26±13.53, respectively, which were significantly lower than that preoperatively (58.23±13.06). The ODI score at 12 months postoperatively was significantly lower than those at 3 and 6 months postoperatively. The VAS scores of low back at 3, 6 and 12 months postoperatively and last follow-up were 2.50±0.83, 1.93±0.84, 1.54±0.82 and 1.46±1.28, respectively, and all these scores were significantly lower than that preoperatively (5.48±1.24). The score at 12 months postoperatively was obviously lower than those at 3 and 6 months. The VAS scores of leg at 3, 6 and 12 months postoperatively and last follow-up were 2.00±1.07, 1.43±1.02, 1.01±1.01 and 0.89±1.39, respectively, and all of them were significantly lower than the preoperative score (4.73±1.84). The incidence of postoperative complications was 0.53% (9/1 706), including 2 cases of intervertebral disc cyst, 2 of intervertebral space infection and 5 of adjacent segment disease. Eleven patients do not relieve postoperatively. The recurrence rate was 10.38% in 177 cases. One year postoperatively was the peak time of disc recurrence, and the patients aged 61 to 90 years had a higher recurrence rate. The reoperation rate for recurrence was 50.85% and total reoperation rate was 5.98%. For the recurrence, 90 cases were treated with surgery and 87 cases were treated conservatively. Conclusion Percutaneous endoscopic lumbar discectomy has good long-term follow-up outcomes in the treatment of lumbar disc herniation.

Keywords

• lumbar disc herniation
• percutaneous endoscopic lumbar discectomy
• surgical treatment
• effect