Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level

Eui-Chan Jang; Kwang-Sup Song; Ki-Ser Kang; Jae-Yoon Kim; Ki-Seong Kim; Jae June Yang; Young-Bong Ko

doi:10.4184/jkss.2009.16.3.186

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Jang, Song, Kang, Kim, Kim, Yang, and Ko: Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level

Original Article

Journal of Korean Spine Surg 2009;16(3):186-193.

Published online: 21 February 2009

DOI: https://doi.org/10.4184/jkss.2009.16.3.186

Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level

Eui-Chan Jang, M.D., Kwang-Sup Song, M.D., Ki-Ser Kang, M.D., Jae-Yoon Kim, M.D., Ki-Seong Kim, M.D.^∗, Jae June Yang, M.D., Young-Bong Ko, M.D.

Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea

^∗Department of Orthopedic Surgery, Jincheon Sungmo Hospital, Chungcheongbuk-do, Korea

Address reprint requests to Kwang-Sup Song, M.D. Department of Orthopedic Surgery, Chung-Ang University Hospital 224-1, Heukseok-dong, Dongjak-gu, Seoul, Korea Tel: 82-2-6299-1589, Fax: 82-2-822-1710, E-mail: ksong70@cau.ac.kr

Received 5 February 2009 Accepted 25 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A prospective, non-randomized study

Objectives

To evaluate the early clinical results of percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy (MD) using a tubular retractor.

Summary of the Literature Review

There are few reports comparing the clinical results of different minimal invasive surgical procedures for disc herniation.

Materials and Methods

Out of 41 patients who underwent a discectomy at the L4-5 level, 16 patients (Group I) underwent PELD and 25 patients (Group II) underwent MD. The surgical techniques were based on the patient's selection. The characteristics of the operation(operation time, time for C-arm, amount of removed disc) were compared with the clinical outcomes by evaluating the SLR (straight leg raising test), leg VAS (visual analogue scale), ODI (Oswestry Disability Index), hospital day, changes in disc height.

Results

Group I showed a larger amount of disc removed and exposure time for the C-arm than group II (p<0.05). However, the hospital day was shorter in group I than in group II (p<0.05). There were no differences in the leg VAS, ODI, the change in disc height and surgery time between the two groups at the last follow up. One case in group I had a neuropraxia of the L5 root that had recovered fully at postoperative 3months. In group II, there was one case of a postoperative hematoma and 2 cases of a dural tear.

Conclusion

Although the early clinical outcomes were similar in both groups, group I showed a larger amount of disc removed and more exposure time to radiation but a shorter hospital stay.

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Keywords: Lumbar disc herniation, Ppercutaneous endoscopic lumbar discectomy, Microdiscectomy, Minimally invasive surgery

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Figures and Tables%

Fig. 1.

Measurement of the amount of removed disc using 5cc syringe. Disc materials extruded through working portal of arthroscopy was added to measure the amount of removed disc in PELD group. arrow: disc material flowed out through the working portal under surgery.

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Fig. 2.

Radiographic measurement of the disc height ratio (introduced by Mochida et al.)

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Fig. 3.

Computed tomographic scan at L4-5 level in prone position preoperatively. white lines: the preoperative trajectories for deciding entry points and angle of guide wire, arrow: the extruded disc, black square: the portion which will be removed disc in disc space to reach the true pathology (black arrow).

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Table 1.

Demographic data between two groups

	^$PELD (N=16)	^%MD (N=25)	P -VALUE
*Sex (male:female)	9:7	17:8	0.61
Age (yrs)	37(20~69)	42(25~62)	0.52
*Disc type (protrusion:extrusion)	10:6	14:11	0.24
Sx duration (months)	3.4(1~18)	4.2(2~22)	0.80
^†SLR (involved leg)	43(30~70)	45(35~65)	0.35
Pre op ^†VAS (leg)	7.3(5~10)	7.1(6~10)	0.32
Pre op ^#ODI	48(40~62)	50(38~68)	0.20
Mean followup (months)	13(6~19)	11(6~18)	0.53

^∗ 2- test (others t-test), Lumbar Discectomy,

^% Microdiscectomy

^† Straight Leg Rasing,

^† Visual Analogue Scale,

^# Oswestry Disability Index,

^$ Percutaneous Endoscopic

Table 2.

The comparison of perioperative factor and clinical outcomes between two groups

	^$PELD (N=16)			^%MD (N=25)			P-VALUE
	Pre op	Discharge	Last F/U	Pre op	Discharge	Last F/U	P-VALUE
*SLR (involved leg)	43(30~70)	84(70~90)	87(80~90)	45(35~65)	87(60~90)	87(80~90)
^†VAS (leg)	7.3(5~10)	1.5(0~4)	1.6(0~4)	7.1(6~10)	1.3(1~4)	1.1(0~5)
^†ODI	48(40~62)	-	1 (2~14)	50(38~68)	-	8(2~12)
Change of the disc height (%)		93(68~100)			94(70~100)
Complication case		1			3
Mean operating time(min)		89(45~180)			97(75~150)		0.13
^#Mean C-arm time(sec)		41(17~120)			15(6~41)		0.03
^#Removed disc(cc)		1.9(0.8~3.1)			1.1(0.5-2)		0.02
^#Mean hospital stay		4(2~8)			8(4~14)		0.03

^∗ Straight Leg Rasing, * p<0.05 in independent t-test, dent t-test,

^$ Percutaneous Endoscopic Lumbar Discectomy,

^% Microdiscectomy

^† Visual Analogue Scale,

^† Oswestry Disability Index,

^# p<0.05 in indepen-

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