A comparative study of single and double incision for L4/5 and L5/S1 double-level percutaneous interlaminar lumbar discectomy

Abstract

ObjectiveThis study aims to investigate the clinical outcome of single and double incision for double-level percutaneous interlaminar lumbar discectomyMethodsA retrospective analysis was performed involving patients with L4/5 and L5/S1 double-level lumbar disc herniation who received percutaneous interlaminar lumbar discectomy (PEID) in our hospital from January 2017 to December 2020. These enrolled patients were divided into single- and double-incision groups, with 25 patients in each group. We compared the incision length, operation time, fluoroscopy times, and length of hospital stay between the two groups. Meanwhile, the postoperative visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association score (JOA), and modified MacNab standard were used to evaluate the outcomes of the patients within the two groups.ResultsIt showed that the single-incision group performed better than double-incision group in incision length, operation time, and fluoroscopy times (P < 0.001). The VAS score, JOA score, and ODI index in the two groups were significantly decreased at the time points of postsurgery, 1 month after surgery, and the last follow-up (P < 0.01), but there was no statistical significance between the two groups involving above parameters (P > 0.05). At the last follow-up, the excellent and good rates of MacNab efficacy in the two groups were 92% and 88%, respectively, but no significant difference was observed between the two groups (P > 0.05).ConclusionBoth the single- and double-incision approaches are effective and safe for managing L4/5 and L5/S1 double-level LDH. Single-incision PEID for treating L4/5 and L5/S1 double-segment lumbar disc herniation has advantages of less trauma, fewer intraoperative fluoroscopy times, and shorter operation time, as compared to double-incision PEID. However, the operation of double-segment LDH through a single laminar incision is difficult, the learning curve is steep, and professional skill is highly required. Importantly, the surgical indications should be strictly grasped.

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

“…We performed a battery of behavioral phenotyping tests to assess general health and physical indices of stress, pain-like behaviors at sites local and distant to the site of injury, spontaneous pain-like behaviors, and psychosocial behavioral testing as a means to also collect information on general well-being ( 69 – 72 ). Similar to other groups examining symptoms associated with IVD injury in rodent models, we examined general health by assaying body weight across time ( 67 ), evoked hypersensitivity to pressure at the site of injury ( 25 , 29 , 36 ) using a pressure algometer applied to the lower back ( 67 ), evoked pain-like behaviors at sites distant to the site of injury using the same pressure algometer but applied to the upper thigh and von Frey monofilament assays on the hindpaws ( 21 , 25 , 28 , 29 , 36 , 61 , 67 , 73 ), and spontaneous pain-like behaviors such as reduced/impaired locomotion during open field gait assays ( 29 , 51 ) and grooming changes post-IVD injury ( 15 , 74 ) as changes in grooming may be indicative of stress and pain in rodents ( 15 , 71 , 74 ). We also examined cold sensitivity as similarly performed by others examining symptoms associated with IVD injury ( 36 ).…”

“…However, the study primarily focused on the intervention effects of a drug rather than characterizing differences between single vs. multi-level injury with respect to disc height, histopathology, and pain-related behaviors, among other features, which could have important clinical implications. In humans, the herniation of two lumbar discs (termed tandem disc herniation) on first presentation has a relative low incidence rate, but is not rare ( 29 ). That said, migration of the lumbar disc herniation to an adjacent disc (either caudally or rostrally) is a significant predictor of disc herniation recurrence and occurs in up to 19% of patients ( 30 , 31 ).…”

Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation

“…LDH is often accompanied by nerve compression symptoms such as sciatica, leg pain, or lower back pain. In clinic, we found that it is not rare for patients to develop double-level LDH, while patients who fail to receive stepwise conservative treatment always need further surgical interventions [ 2 ]. Conventional open lumbar discectomy (COLD) and percutaneous endoscopic lumbar discectomy (PELD) are the common surgical approaches for LDH [ 3 ].…”