Efficacy comparison of endoscopic spinal surgery combined with annuals fibrosus repair via the transforaminal and interlaminar approaches in the treatment of lumbar disc herniation
Objective:To explore the clinical efficacy of endoscopic spinal surgery combined with annuals fibrosus repair via the transforaminal and interlaminar approaches in the treatment of lumbar disc herniation(LDH).Methods:A retrospective analysis was conducted on the clinical data of 65 LDH patients admitted to the First People's Hospital of Taicang from March 2018 to February 2022.Patients were divided into two groups on the basis of the different approaches of endoscopic spinal surgery:the transforaminal group(32 cases)and the interlaminar group(33 cases).Perioperative indicators,pain levels,lumbar and spinal nerve functions before and 3 months after surgery,complication rates at the 3 months postoperatively,and recurrence rates within 2 years of follow-up were compared between the two groups.Results:The follow-up duration ranged from 24 to 38 months,with an average of(31.4±5.8)months.The interlaminar group presented a shorter operative time and a reduced X-ray exposure frequency compared to the transforaminal group(all P<0.05).There was no statistically significant difference in terms of blood loss or hospital stay between the two groups(all P>0.05).Both groups showed significant improvement in the Visual Analogue Scale(VAS)for pain and the Oswestry disability index(ODI)at 3 months postoperatively compared to preoperative values(all P<0.05),with no significant difference between the groups(all P>0.05).The two groups showed decreased nerve latency and increased nerve conduction velocity at 3 months postoperatively compared to preoperative levels(all P<0.05),with no significant difference between the groups(all P>0.05).There was no statistically significant difference in the incidence of complications at 3 months after surgery between the two groups(P>0.05).There was no significant difference in 2-year recurrence rates(P>0.05),however,the time to recurrence was delayed in the interlaminar group compared to the transforaminal group(P<0.05).Conclusions:Endoscopic spinal surgery combined with annulus fibrosus repair via the transforaminal and interlaminar approaches in the treatment of LDH has comparable efficacy in improving pain,lumbar function and spinal nerve function,with similar risks of surgical complications.However,the interlaminar approach can reduce the operative time,decrease X-ray exposure,and delay the time to recurrence of LDH.
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