Minimum Seven-Year Follow-Up Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Lumbar Degenerative Disease

Abstract

Purpose To investigate the long-term (> 7 years) clinical outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease to address postoperative problems including postoperative dysesthesia (POD), residual back pain and segmental instability. Methods Inclusion and exclusion criteria were established. All patients who met the above criteria were treated by PELD using the transforaminal approach. Limited discectomy was performed to preserve the disc material in the intervertebral space as much as possible. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back pain (VAS-B) and leg pain (VAS-L) and Modified MacNab’s criterion were used for clinical evaluation. Radiographic parameters including height of intervertebral disc and segmental instability were also evaluated. Results Forty-two patients (24 men and 18 women) who met our inclusion and exclusion criteria were included in our study. The average follow-up period was 95.71±5.63 months (ranging from 87 to 105 months). There were no neurological complications associated with the operation. POD was found in 14.29% of patients, while only 2 patients (4.76%) complained of mild dysesthesia at final follow-up. Two patients (4.76%) required revision surgery during the follow-up period. The final follow-up ODI, JOA score, VAS-B and VAS-L were significantly better than preoperative values. The average disc-height ratio was 84.52±5.66% of the preoperative disc height. No instability at the operation level was noted at final follow-up. Conclusion Our study showed that PELD using the transforaminal approach can provide favorable results after a long-term follow-up period. POD is a common complication at initial prognosis. Limited discectomy can preserve the disc height well and minimize the risk of residual back pain.

Clinical Efficacy of Transforaminal Endoscopic Lumbar Discectomy for Lumbar Degenerative Diseases: A Minimum 6-year Follow-up

“…Sang et al [8] reported that DH 10 years after TELD was 81.54 ± 17.40% of that before TELD, and there was no signi cant difference between the two. Li et al [4] reported that DH 7 years after TELD was 84.52 ± 5.66% of that before TELD, with no signi cant difference between the two. Our study found no signi cant difference in DH between the patients at the last follow-up and before the operation, which was consistent with the results of the above scholars.…”

“…is increasingly widely used in the treatment of lumbar degenerative diseases because of its advantages of less trauma, less bleeding and rapid recovery [1,4] . At present, there are many reports about the short-term e cacy of TELD [1,2,5−7] , but there are few reports on the medium-and long-term clinical evaluation of TELD for more than 5 years.…”

“…Multiple experts [9][10][11] conducted studies for at least 5 years and found that TELD could achieve satisfactory longterm clinical results. Li et al [4] followed 42 TELD patients for at least 7 years; 6 patients (14.29%) showed POD, only 2 patients (4.76%) showed mild sensory impairment during the last follow-up, 2 patients (4.76%) underwent revision surgery during the last follow-up period, and no instability of surgical segments was found during the last follow-up. They concluded that TELD can achieve good results after long-term follow-up, that postoperative sensory impairment was a common early complication and that limited intraoperative disc removal could well protect DH and minimize the risk of residual back pain.…”

“…The effect of the operation on the stability of the operative segment is also an important index for the evaluation of postoperative e cacy. Sang et al [8] reported that no obvious lumbar instability was found 10 years after TELD, and Li et al [4] reported that no obvious lumbar instability was found 7 years after TELD. Our study found that there was no signi cant difference in ROM between the last follow-up patients and those before TELD, and no obvious lumbar instability was found.…”

“…Sang et al 8] reported that the 10-year postoperative recurrence rate of TELD was approximately 9.6% (6/62). Li et al [4] reported that the postoperative recurrence rate of TELD was approximately 4.76% (2/42) 7 years after TELD. Thomas et al [12 ] reported that the TELD recurrence rate was approximately 4.76% (4/84).…”