Objective. Transforaminal endoscopic lumbar discectomy (TELD) is an effective treatment for patients with lumbar disc herniation (LDH) with failure of conservative treatment. However, defects in the annulus fibrosus after TELD usually lead to a recurrence of LDH. Platelet-rich plasma (PRP) injection has shown promising potential for the repair of injured tissues. The combination of TELD and PRP injection has rarely been reported. Hence, this study aimed to evaluate the effectiveness, disc remodeling, and recurrence rate of LDH in TELD with or without PRP in LDH treatment. Methods. A total of 108 consecutive patients who underwent TELD were prospectively registered between July 2018 and December 2019 (https://clinicaltrials.gov/ct2/show/ChiCTR1800017228). Fifty-one and fifty-seven patients underwent TELD with PRP injections and TELD only, respectively. The visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria were evaluated, and perioperative complications were documented. The disc protrusion, spinal cross-sectional area (SCSA), and disc height were measured on MRI and evaluated preoperatively, postoperatively, and at regular follow-up. Results. All patients were followed up. Clinical improvement was noted in both groups. There were statistical differences in the VAS scores of back and leg pain and ODI between the two groups at 3 months, 6 months, and 1 year follow-up ( P < 0.05 ); the improvement in the PRP group was significant. The disc protrusion and SCSA on MRI in the PRP group showed better improvement, with lower recurrence rate, than that in the control group at the final follow-up ( P < 0.05 ). No adverse events were reported in our study following PRP injection. Conclusion. Our study showed that TELD with PRP injection was a safe and effective treatment for patients with LDH in the medium and long-term follow-up. PRP injection was beneficial for disc remodeling after endoscopic discectomy and decreased the recurrence of LDH.

ObjectiveTo compare the clinical outcomes of unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS) via the posterior approach with those of interlaminar endoscopic lumbar discectomy (IELD) for the treatment of L5/S1 lumbar disc herniation.MethodsWe collected the clinical data of patients with L5/S1 lumbar disc herniation who had undergone endoscopic surgery at our center from January 2020 to July 2021, and 92 patients were included. They were divided into UBE/BESS (n = 42) and IELD (n = 50) groups. The incision length, operative time (overall operative, extracanal operative, and intracanal decompression times), intraoperative radiation exposure dose, changes in hemoglobin before and after surgery, postoperative hospital stay, visual analog scale (VAS) score for low back pain and leg, and Oswestry disability index (ODI) were statistically analyzed.ResultsOne case incurred dural tear in the UBE/BESS group, and one case developed recurrence in the IELD group. Postoperatively, the VAS score and ODI index decreased significantly in both groups (P &lt; 0.01). VAS and ODI scores (preoperative as well as 3 days, 3 months, 6 months, and 12 months after surgery), the overall operative time, and postoperative hospital stay were not significantly different between the two groups (P &gt; 0.05). No statistical difference in intraoperative radiation exposure dose was noted between the two groups (P &gt; 0.05). The surgical incision length was greater in the UBE/BESS group (P &lt; 0.01), and pre- and postoperative hemoglobin changes were more pronounced in the UBE/BESS group (P &lt; 0.01). The UBE/BESS group had a longer extracanal operative time and shorter intracanal decompression time (P &lt; 0.01).ConclusionsThe clinical efficacy of UBE/BESS for L5/S1 lumbar disc herniation is comparable to that of IELD. Intraoperative radiation exposure doses were similar in both techniques. UBE/BESS required more time to identify tissue structures and a larger working space when operating outside the spinal canal; however, the efficiency of nucleus pulposus removal and nerve root release inside the spinal canal superseded that in IELD. Furthermore, the surgical incision in the UBE/BESS technique was longer, with greater actual blood loss during surgery, thus rendering UBE/BESS inferior to the IELD technique in terms of surgical trauma. Nonetheless, no significant difference was noted between the two techniques in the postoperative recovery time of patients.

Objective. This study sets out to investigate the role of magnetic resonance imaging (MRI) combined with magnetic resonance myelography (MRM) in patients after percutaneous transforaminal endoscopic discectomy (PTED) and to evaluate its value in postoperative rehabilitation. Methods. The clinical date of 96 patients with lumbar disc herniation (LDH) after PTED was retrospectively analyzed. The enrolled patients were divided into MRI group ( n = 32 ) and MRI + MRM group ( n = 64 ) according to whether MRM was performed. The nerve root sleeve (morphology, deformation) and dural indentation, intervertebral space height (ISH), intervertebral space angle (ISA), degree of pain (Visual Analogue Scale (VAS)), vertebral function (Japanese Orthopaedic Association (JOA)), and long-term recurrence were compared between the two groups. Results. Compared with the MRI group, the MRI + MRM group better displayed nerve root morphology, sheath sleeve deformation, and dural indentation. Both MRI and MRI + MRM showed ISH and ISA changes well. Compared with the MRI group, the MRI + MRM group had a significantly lower VAS score for lumbar and leg pain, a significantly higher JOA score, and a significantly lower 2-year recurrence rate. Conclusion. MRM combined with MRI is more beneficial to improve the prognosis of LDH patients after PTED.

BackgroundTo evaluate the clinical outcome of full endoscopic discectomy using a novel trajectory via a transpedicular approach.MethodThirty-five patients were enrolled in this retrospective study between July 2014 and October 2019 in the Beijing Haidian Hospital. All patients were treated with full-endoscopic lumbar discectomy via a transpedicular approach with an oblique trajectory. The imaging parameters, including pedicle height and angle of trajectory, were recorded. The preoperative and postoperative clinical data were collected for statistical analysis.ResultsAll patients underwent successful surgery without severe complications. We compared the visual analogue scale and Oswestry disability index scores before and after surgery. The differences were statistically significant (p &lt; 0.05). According to the modified Macnab criteria, the good-to-excellent rate was 85.7% at the last follow-up. The average angles of trajectory in the sagittal and coronal planes were 34.5° ± 2.9° and 47.1° ± 5.0°, respectively.ConclusionThe new trajectory of the transpedicular approach with a full endoscopic technique for an extremely downward-migrated disc herniation showed excellent results in a small sample study. A precise surgical plan is required, comprising measurements of the pedicle height and angle of the bone tunnel.

Background: This study aimed to evaluate the effectiveness of transforaminal endoscopic lumbar discectomy with or without platelet-rich plasma (PRP) in lumbar disc herniation treatment. Additionally, we aimed to identify whether the PRP injection could improve annulus fibrosus defects based on magnetic resonance imaging data.Methods: Sixty patients with lumbar disc herniation were recruited and randomized to receive either transforaminal endoscopic lumbar discectomy with (PRP group, n=30) or without (control group, n=30) PRP injection. The visual analog scale score of back/leg pain and Oswestry disability index were recorded at 3 days, 6 months, and 1 year after surgery. Postoperative magnetic resonance imaging data were examined to determine the effects of PRP injection.Results: No adverse events were reported in our study following the injection of PRP. Clinical improvement was noted in both groups. The visual analog scale score for leg pain at 3 days post-operation and back pain at 6 months post-operation were lower in the PRP group than those in the control group (P<0.05). The magnetic resonance imaging data indicated the disc height decreased by 12% in the PRP group and 17% in the control group, whereas the spinal cross-sectional area increased by 15% in the PRP group and 6% in the control group after a 1-year follow-up. However, no statistically significant differences were found.Conclusions: Transforaminal endoscopic lumbar discectomy with PRP injection around the annulus fibrosus defect was safe and could improve the clinical outcomes at the early postoperative stage. Moreover, PRP injection exerted no negative effects.Trial Registration: ChiCTR 1800017228