Journal of Pain Research (Dec 2021)

Better Functional Outcome and Pain Relief in the Far-Lateral-Outside-in Percutaneous Endoscopic Transforaminal Discectomy

  • Wang SF,
  • Hung SF,
  • Tsai TT,
  • Li YD,
  • Chiu PY,
  • Hsieh MK,
  • Kao FC

Journal volume & issue
Vol. Volume 14
pp. 3927 – 3934

Abstract

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Sheng-Fen Wang,1,* Shih-Feng Hung,2,* Tsung-Ting Tsai,2 Yun-Da Li,2 Ping-Yeh Chiu,2 Ming-Kai Hsieh,2 Fu-Cheng Kao2,3 1Department of Anesthesiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; 2Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; 3Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan*These authors contributed equally to this workCorrespondence: Fu-Cheng KaoDepartment of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fusing St., Gueishan, Taoyuan, 333, TaiwanTel +886-3-3281200 ext. 3612Fax +886-3-3278113Email [email protected]: Even though percutaneous endoscopic transforaminal discectomy (PETD) has been widely used for the surgical treatment of lumbar herniated disc, there are only a few studies directly comparing the clinical outcomes between microdiscectomy (MD) and PETD. Therefore, further studies are needed in order to compare the clinical outcomes between PETD and MD on a single level more thoroughly.Methods: We proposed a far-lateral-outside-in technique for PETD to get an entry point without complex planning and facet violation. From September 2017 to September 2019, a total of 155 patients (69 with PETD and 86 with MD) were enrolled for this retrospective study, with the inclusion criteria: single level between L2 and S1, clinical sciatica for at least 6 weeks, and failed attempts with non-surgical treatments. Patients were excluded due to cauda equina syndrome, progressive neurologic deficits, history of lumbar spinal surgery, endplate modic changes, severe disc degeneration and less than 24 months of follow-up.Results: PETD showed significantly shorter surgery time and less intraoperative blood loss compared to MD. The difference between PETD and MD in VAS back pain (but not VAS leg pain) at follow-up time was significant. The ODI improvement in the follow-up time of 6 months between the 2 groups showed a significant difference (PETD: 31.23± 6.59, MD: 39.85± 7.81, p < 0.001). MD had a significantly higher chance of postoperative wound infection and poor healing, while PETD was more likely to have recurrence of the herniated disc.Conclusion: MD has been the gold standard procedure for LDH. However, with the advanced endoscopic technology and surgical technique, PETD has emerged as an alternative method due to higher functional outcome and less wound problems.Keywords: microdiscectomy, PETD, discectomy

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