Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12928-12935
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12928
Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation
Zi-Han Zhang, Qian Du, Fu-Jun Wu, Wen-Bo Liao
Zi-Han Zhang, Fu-Jun Wu, Wen-Bo Liao, Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Qian Du, Department of Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Zhang ZH collected data and wrote and revised the manuscript; Liao WB designed the study; Du Q interpreted and analyzed the data; Wu FJ collected the data; and all authors approved the final version of the manuscript.
Supported by Science and Technology Support Plan of Guizhou Science and Technology Department, No. [2019]2812; and National Natural Science Foundation of China, No. 82060415.
Institutional review board statement: This study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the ethics committee of the Affiliated Hospital of Zunyi Medical University.
Informed consent statement: Written informed consent was obtained from all the patients.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: This is an open-access article that could be downloaded and shared provided that it is properly cited. This work cannot be changed in any way or used commercially without permission from the journal.
STROBE statement: The manuscript was revised according to the STROBE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bo Liao, MD, Chief Physician, Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563003, Guizhou Province, China. wenbo_liao@163.com
Received: October 18, 2022
Peer-review started: October 18, 2022
First decision: November 4, 2022
Revised: November 18, 2022
Accepted: November 24, 2022
Article in press: November 24, 2022
Published online: December 16, 2022
Processing time: 56 Days and 20.7 Hours
ARTICLE HIGHLIGHTS
Research background

Disc herniation (DH) is the most common degenerative disease of the spine, and many patients require surgical treatment. Open discectomy via the intervertebral foramen was first performed in the early 20th century. Even though full-endoscopic discectomy can be performed via either the interlaminar or foraminal approach in most patients with lumbar DH (LDH), it is difficult to determine which approach is better.

Research motivation

Total endoscopic discectomy has become the most commonly performed minimally invasive procedure for DH. There are some studies on full-endoscopic discectomy; however, there are few comparative studies on interlaminar and foraminal approaches in the treatment of DH by a total endoscopic discectomy.

Research objectives

The purpose of this study was to investigate the optimal approach for a total endoscopic discectomy and its influence on lumbar pain, leg pain, and lumbar function in patients with DH.

Research methods

This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021. All patients were randomly divided into the following two groups: The observation group, which consisted of 62 patients who underwent surgery using the interlaminar approach, and the control group, which consisted of 58 patients who were operated via the foramina approach. The treatment effects, perioperative indicators, functional recovery, pain, and quality of life were compared between the two groups.

Research results

The treatment effect in the observation group was significantly better than that in the control group. The hospitalization time was significantly shorter in the observation group than in the control group. The Japanese Orthopaedic Association score and Oswestry Disability Index decreased significantly in both groups after treatment, but the observation group showed lower scores than the control group. The visual analog scale scores of lower back and leg pain in the two groups were significantly reduced after treatment, with the observation group showing lower scores than the control group. A short form of the Arthritis Impact Measurement Scales 2 measurement scale score and Barthel index of the lower back of the two groups increased significantly after treatment, with the observation group showing significantly higher scores than the control group.

Research conclusions

Patients with DH who were treated with total endoscopic discectomy through an interlaminar approach had a reduced degree of pain in the lower back and leg and significant lumbar function recovery, suggesting that the treatment effect was remarkable.

Research perspectives

Total endoscopic discectomy also has some disadvantages, such as a steep learning curve. Surgeons must master the key techniques of total endoscopic discectomy through study courses and personal experience. In addition, muscles, disc cysts, and ligaments may be difficult to identify endoscopically, increasing the risk of congenital injuries. In a total endoscopic discectomy, if adequate decompression of the herniated disc is not possible because of severe intracanal hemorrhage or anatomic obstruction, conventional surgery should be performed if necessary.