Short-term outcome of percutaneous spinal endoscopic technique of fully visualization foraminoplasty for lumbar disc herniation

Abstract

Objective To explore the clinical early efficacy of fully visualization foraminoplasty in treatment of lumbar disc herniation with percutaneous spinal endoscope. Methods A retrospective analysis was conducted on the clinical data of 32 patients who underwent percutaneous spinal endoscopic operation of fully visualization foraminoplasty for lumbar disc herniation at Department of Neurosurgery, Minhang Hospital, Fudan University (18 cases) and Department of Neurosurgery, Zhongshan Hospital, Fudan University (14 cases) from June 2016 to December 2018. Lumbar MRI was reviewed after surgery and visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were employed for outcome evaluation. Outpatient follow-up was conducted for all patients and included the assessment based on VAS, JOA score, ODI and modified MacNab criteria. Results All 32 patients successfully underwent the operation. No postoperative infection, spinal canal hematoma or neurological dysfunction occurred. Postoperative review of lumbar spine MRI showed satisfactory excision of nucleus pulposus. Compared with preoperative conditions, 32 patients′ VAS score (2.21±1.18 points vs. 6.25±1.46 points) and ODI [(30.28±7.42)% vs. (68.63±11.04)%] were decreased 2 days after surgery (both P<0.001), and the JOA score (16.66±1.58 points vs. 12.43±1.85 points) was increased 2 days after surgery (P<0.001). The follow-up duration of 32 patients was 15±5 months (10-20 months). With the increase of follow-up duration, the VAS score of 32 patients showed a downward trend, the JOA score showed an upward trend, and the ODI showed a downward trend (F=187.43, 72.54, and 564.38, all P <0.001). At 12-month follow-up, the outcomes assessed according to modified MacNab criteria were: excellent in 20 patients, good in 9 patients, fair in 2 patients and poor in 1 patient. The rate of excellent and good outcomes was 90.6 % (29/32). Conclusions Percutaneous spinal endoscopic technique of fully visualization foraminoplasty for lumbar disc herniation could improve pain and nerve function, help patients to resume life and work, and has satisfactory short-term outcome. Its long-term therapeutic effect still needs to be further observed. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Percutaneous endoscopic; Visualization; Treatment outcome