Percutaneous Endoscopic Transforaminal Discectomy with Foraminoplasty in the Treatment of L4-L5 and L5-S1 Disc Herniation: A Minimum 1-year Follow-up Study.

Abstract

Background The anatomic and biomechanical aspects of the L5-S1 level present unique operative challenges compared with the L4-L5 level. We aim to explore the clinical outcomes and radiographic measurements of L4-L5 patients compared with L5-S1 patients after undergoing Percutaneous Endoscopic Transforaminal Discectomy with Foraminoplasty (PETDF). Methods A total of 84 patients who underwent PETDF for LDH treatment between January 2017 and June 2020 were included in this study. Preoperative, perioperative, demographic data, clinical and radiographic outcomes were compared between patients with L4-L5 involvement and patients with L5-S1 involvement. Results There were no significant differences between the two groups in terms of Age, Gender, Follow-up time, the postoperative questionnaire results (Visual Analog Scale [leg], VAS [lower back], and Oswestry Disability Index) or the Excellence and Good Rate and Recurrence Rate. There was no significant difference in the mean preoperative to postoperative change in Intervertebral Space Height (ISH), Intervertebral Space Angle (ISA), Lumbar Lordosis, Foraminal Area (FA) of Operating Side and FA of Contralateral Side between the 2 groups. The mean VAS of Leg Pain, VAS of Lower Back Pain and ODI postoperative scores were significantly improved over the preoperative scores in each of the two groups and the ISH, ISA, FA of Operating Side and FA of Contralateral Side postoperative were significant difference form preoperative Conclusion PETDF is an effective and safe treatment approach for lumbar disc herniation in both L4/L5 and L5/S1 level. Although it may increase lumbar ISA and result in low CFA (contralateral foraminal area) and ISH.