A comparative study of one-hole split endoscope discectomy,unilateral biportal endoscopy discectomy and per-cutaneous endoscopic transforaminal discectomy for treatment of sequestered lumbar disc herniation
Objective:To compare the clinical outcomes and safety of one-hole split endoscope(OSE)discectomy,unilateral biportal endoscopy(UBE)discectomy and percutaneous endoscopic transforaminal discectomy(PETD)in treatment of sequestered lumbar disc herni-ation(LDH).Methods:The medical records of 94 patients with sequestered LDH were retrospectively analyzed.Twenty-six patients were treated with OSE discectomy(OSE group),37 ones with UBE discectomy(UBE group),and 31 ones with PETD(PETD group).The inci-sion length,intraoperative X-ray exposure,pre-incision preparation time,endoscopic operation time,total operative time,reduction of hema-tocrit,total blood loss during the procedure and at postoperative day 1,consumption of irrigation fluid,volume of removed nucleus pulposus,removal ratio of nucleus pulposus,lumbago-leg pain visual analogue scale(VAS)score,Oswestry disability index(ODI),complication inci-dence and LDH recurrence rate were compared among the 3 groups.Results:①The incision length was longer in UBE group compared to OSE group and PETD group(P=0.000,P=0.000),and was longer in OSE group compared to PETD group(P=0.000).The intraopera-tive X-ray exposure was more in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,the comparison be-tween OSE group and UBE group revealed no significant differences(P=0.958).The pre-incision preparation time was longer in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,the comparison between OSE group and UBE group revealed no significant differences(P=0.388).The endoscopic operation time was longer in PETD group compared to UBE group and OSE group(P=0.016,P=0.022),while,the comparison between OSE group and UBE group revealed no significant differences(P=0.922).The re-duction of hematocrit was lower in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,there was no statis-tical difference between OSE group and UBE group(P=0.206).The total blood loss during the procedure and at postoperative day 1 was less in PETD group compared to OSE group and UBE group(P=0.000,P=0.000),while,there was no statistical difference between OSE group and UBE group(P=0.220).The consumption of irrigation fluid was more in OSE group compared to UBE group and PETD group(P=0.000,P=0.000),and was more in UBE group compared to PETD group(P=0.000).There was no statistical difference in total op-erative time,volume of removed nucleus pulposus and removal ratio of nucleus pulposus among the 3 groups.②The lumbago-leg pain VAS score and ODI decreased at postoperative month 12 compared to pre-operation in the 3 groups(Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.862,P=0.000;Z=-4.460,P=0.000,Z=-5.304,P=0.000,Z=-4.864,P=0.000;Z=-4.460,P=0.000,Z=-5.306,P=0.000,Z=-4.863,P=0.000),while,the differences were not statistically significant in lumbago-leg pain VAS score and ODI evaluated at pre-operation and postoperative month 12 among the 3 groups(H=0.054,P=0.973,H=0.617,P=0.734;H=1.646,P=0.439,H=5.411,P=0.067;H=0.647,P=0.526,H=0.201,P=0.904).③One patient in OSE group and one patient in PETD group suffered from nerve injury,meanwhile,the spinal cord compression-like syndrome and erector spinae muscle hernia were found in one patient respectively in UBE group.The difference in complication incidence was not statistically significant among the 3 groups(P=1.000).The recrudescent LDH were found in 2 patients in PETD group,the difference in the recurrence rate of LDH was not statistically significant among the 3 groups(P=0.181).Conclusion:The OSE discectomy,UBE discectomy and PETD are similar to each other in clin-ical outcomes and safety in treatment of sequestered LDH.The PETD displays the advantages of shorter incision,less blood loss and con-sumption of irrigation fluid compared to the former two,whereas,the former two exhibit fewer intraoperative X-ray exposure,shorter pre-inci-sion preparation time and endoscopic operation time compared to PETD.
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