Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

Abstract

Background: Approximately one-third patients with lumbar disc herniation (LDH) who accepted traditional discectomy presented with reactive pain few days after operation, and this reactive pain affected short-term clinical outcomes and postoperative early functional exercise. Recent studies demonstrated that this reactive pain may be ascribed to the increased release of inflammatory mediators caused by surgical trauma. Percutaneous transforaminal endoscopic discectomy (PTED), one of the minimal invasive spinal surgical techniques, was demonstrated to be obviously associated with less soft tissue trauma. The aim of this study is to investigate the postoperative reactive pain in LDH patients undergoing PTED compared with open discectomy. Material and methods: This study included 72 patients (PTED vs. open discectomy: 41 vs. 31), and the incidence of reactive pain, as well as both the extent and duration of reactive pain, were evaluated in both patient groups. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and/or after operation. Results: Compared with open discectomy, patients undergoing PTED showed lower CK and IL-6 in blood samples, as well as lower IL-6 and IL-1β in drainage fluid samples. Significantly greater number of patients undergoing open discectomy showed reactive pain compared to those undergoing PTED (13/31, 41.9% vs. 7/41, 17.0%; P < 0.05), and the duration of reactive pain is mildly longer in the former (P < 0.05). In both patient groups, the patients with reactive pain showed increased IL-6 and IL-1β in drainage fluid samples, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and both duration and extent of reactive pain in both patient groups (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative reactive pain, and PTED may effectively reduce the local inflammatory substances accumulation at the surgical site and reduce the risk of reactive pain.