Comparison of the Clinical Effect of Simple Nucleotomy for the Treatment of Single-segment Lumbar Disc Herniation Using a Microscope and Percutaneous Transforaminal Endoscope

Abstract

Objective: To compare the clinical effect of single-segment lumbar intervertebral herniation with simple nucleotomy using a microscope and percutaneous transforaminal endoscope. Methods: From May 2016 to October 2018, a total of 120 patients who underwent simple nucleotomy in our hospital for single-segment lumbar disc herniation were selected. According to the surgical methods, they were randomly divided into 2 groups: the microscopical treatment group included 60 cases, aged 28-65 years, with an average of 48.73 ± 12.35 years; the percutaneous transforaminal endoscopic treatment group included 60 cases, aged 29-67 years, with an average of 49.36 ± 11.76 years. The differences in the JOA score, ODI index, VAS score, serum CPK content, operation time, intraoperative bleeding, incision length, intraoperative X-ray fluoroscopy, hospital stay, and 1-year recurrence (secondary revision surgery) between the two groups were analysed. Results: On the second day after surgery, the serum CPK contents were higher than before surgery in both groups (P<0.01), and the CPK content was higher in the microscopical treatment group than in the percutaneous endoscopic treatment group (P<0.01). The JOA score at 1 year after surgery was significantly higher than before surgery, and the ODI index and VAS score at 1 year after surgery were significantly lower than before surgery in each group (P<0.01). Compared with the percutaneous endoscopic treatment group, the intraoperative bleeding and the lengths of incision and hospital stay were significantly increased (P<0.01) and the operation time (P<0.05) and number of X-ray fluoroscopies during the operation (P<0.01) were significantly reduced in the microscopic treatment group. At 1 year after surgery, compared with the microscopic treatment group, 2 cases of complications were found in the percutaneous endoscopic surgery group. One case was a postoperative recurrence, and the other one case was endoscopic operative failure, which received a second revision surgery using a microscope. Conclusion: Simple nucleotomy for the treatment of single-segment lumbar intervertebral herniation has good clinical effects using a microscope and percutaneous transforaminal endoscope. The percutaneous transforaminal endoscope has the advantages of less trauma, less bleeding, and shorter hospital stay, while the microscope has the advantages of shorter operation time and less intraoperative X-ray fluoroscopy.