Wei Sun1, Wenjie Yu2, Guangliang Hu3*
1Sports medicines, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266011, China - 2Department of Orthopedics, Rushan People's Hospital, Weihai, 264500, China - 3Department of Orthopedics, Qing Dao Municipal Hospital, Qingdao, 266087, China
Objective: To analyze the clinical efficacy, inflammatory factors, and recurrence factors of lumbar disc herniation (LDH) treated by endoscopic transforaminal/interlaminar approach.
Methods: From April 2016 to May 2018, 204 patients with lumbar disc herniation who received different endoscopic approaches in our hospital were selected and divided into the transforaminal approach group (98 cases) and the interlaminar approach group (106 cases) according to the operation methods. The excellent and good rates of the two groups were evaluated 3 months after operation; the levels of inflammatory factors in the two groups were detected before and one week after the operation. According to the recurrence within 2 years, the patients were divided into nonrecurrence group and the recurrence group.
Results: Three months after the operation, the clinical efficacy of the two groups was evaluated. The excellent and good rate of the transforaminal approach group was 95.92%, and that of the intervertebral disc approach group was 93.40%. There was no significant difference between the two groups (P>0.05). The levels of CRP, CK, and IL-6 in group A were significantly lower than those before the operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Among 204 patients, 12 patients relapsed within 2 years, and the recurrence rate was 5.88%. Univariate analysis showed that the Modic sign, VAS score before and after operation difference, and JOA score improvement rate were the factors influencing postoperative recurrence of lumbar disc patients (P<0.05). Logistic regression analysis showed that Modic change was a risk factor for postoperative recurrence of lumbar intervertebral disc patients, and the improvement rate of JOA score was a protective factor for postoperative recurrence of lumbar intervertebral disc patients (P<0.05).
Conclusion: endoscopic transforaminal/interlaminar approach is effective in the treatment of lumbar disc herniation, and the clinical approach should be determined according to the anatomical characteristics to ensure the therapeutic effect; Modic change is a risk factor for postoperative recurrence of patients with lumbar intervertebral disc, intervention measures should be taken to reduce the recurrence rate.
Spinal endoscopy, transforaminal approach, interlaminar approach, lumbar disc herniation, efficacy, inflammatory factors, recurrence.