Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Haifeng , SONG Yang ,  WANG Naiguo

Department of Spinal Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan Shandong, 250021, P. R. China;

Corresponding author：

WANG Naiguo, Email: naiguow@163.com

Keywords：

Unilateral biportal endoscopy; percutaneous endoscopy; lumbar disc herniation; discectomy

DOI：

10.7507/1002-1892.202205129

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Objective To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). Methods The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups (P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients’ pain and functional recovery were evaluated by VAS score and ODI before and after operation. Results The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group (P<0.05); there was no significant difference between PELD group and UBED group (P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group (P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation (P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group (P<0.05), but there was no significant difference between PELD group and FD group (P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation (P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group (P<0.05), and there was no significant difference between FD group and UBED group (P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group (P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group.Conclusion UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.

Citation： WANG Haifeng, SONG Yang, WANG Naiguo. Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1200-1206. doi: 10.7507/1002-1892.202205129 Copy

1.	Xue J, Song Y, Liu H, et al. Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis. J Back Musculoskelet Rehabil, 2022, 35(3): 505-516.
2.	Haro H, Ebata S, Inoue G, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar disc herniation, third edition-secondary publication. J Orthop Sci, 2022, 27(1): 31-78.
3.	中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会, 骨科康复学组. 腰椎间盘突出症诊疗指南. 中华骨科杂志, 2020, 40(8): 477-487.
4.	Vialle LR, Vialle EN, Suárez Henao JE, et al. Lumbar disc herniation. Rev Bras Ortop, 2015, 45(1): 17-22.
5.	Long DM, BenDebba M, Torgerson WS, et al. Persistent back pain and sciatica in the United States: patient characteristics. J Spinal Disord, 1996, 9(1): 40-58.
6.	Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 2009, 12(4): 699-802.
7.	van den Hout WB, Peul WC, Koes BW, et al. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ, 2008, 336(7657): 1351-1354.
8.	Peul WC, van den Hout WB, Brand R, et al. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ, 2008, 336(7657): 1355-1358.
9.	Mixter WJ, Barr JS. Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med, 1934, 211: 210-214.
10.	Love GJ, Walsh MN. Protruded intervertebral disks report of one hundred cases in which operation was performed. JAMJ, 1938, 111(5): 396-400.
11.	Hijikata S, Yamagishi M, Nakayama T, et al. Percutaneous nuclectomy: A new treatment method for lumbar disc herniation. Toden Hosp, 1975, 5(1): 5-13.
12.	Yasargil MG. Microsurgical operation of herniated lumbar disc//R. Wüllenweber, et al. Lumbar Disc Adult Hydrocephalus. Berlin Heidelberg: Springer-Verlag, 1977: 81.
13.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
14.	Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J, 2002, 2(1): 41-48.
15.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
16.	Yang JS, Chu L, Chen CM, et al. Foraminoplasty at the tip or base of the superior articular process for lateral recess stenosis in percutaneous endoscopic lumbar discectomy: A multicenter, retrospective, controlled study with 2-year follow-up. Biomed Res Int, 2018, 2018: 7692794. doi: 10.1155/2018/7692794.
17.	Lee CH, Choi M, Ryu DS, et al. Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: A meta-analysis. Spine (Phila Pa 1976), 2018, 43(24): 1756-1764.
18.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
19.	Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
20.	Ding W, Yin J, Yan T, et al. Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation. Orthopade, 2018, 47(7): 574-584.
21.	Ito Z, Shibayama M, Nakamura S, et al. Clinical comparison of unilateral biportal endoscopic laminectomy versus microendoscopic laminectomy for single-level laminectomy: A single-center, retrospective analysis. World Neurosurg, 2021, 148: e581-e588.
22.	Jiang HW, Chen CD, Zhan BS, et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res, 2022, 17(1): 30. doi: 10.1186/s13018-022-02929-5.
23.	Lee JK, Amorosa L, Cho SK, et al. Recurrent lumbar disk herniation. J Am Acad Orthop Surg, 2010, 18(6): 327-337.
24.	Li Z, Yang H, Liu M, et al. Clinical characteristics and risk factors of recurrent lumbar disk herniation: A retrospective analysis of three hundred twenty-one cases. Spine (Phila Pa 1976), 2018, 43(21): 1463-1469.
25.	Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: Indications and complications. Pain Physician, 2020, 23(1): 49-56.
26.	Wang H, Zhou Y, Li C, et al. Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy. J Neurosurg Spine, 2015, 23(3): 320-325.
27.	刘雅普, 高利峰, 徐永辉, 等. 经皮经椎间孔入路内镜下椎间盘切除术治疗腰椎间盘突出症术中并发类脊髓高压症的临床研究. 中国脊柱脊髓杂志, 2019, 29(4): 382-384.
28.	Joh JY, Choi G, Kong BJ, et al. Comparative study of neck pain in relation to increase of cervical epidural pressure during percutaneous endoscopic lumbar discectomy. Spine (Phila Pa 1976), 2009, 34(19): 2033-2038.
29.	Guan X, Wu X, Fan G, et al. Endoscopic retrieval of a broken guidewire during spinal surgery. Pain Physician, 2016, 19(2): E339-E342.

1. Xue J, Song Y, Liu H, et al. Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis. J Back Musculoskelet Rehabil, 2022, 35(3): 505-516.
2. Haro H, Ebata S, Inoue G, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar disc herniation, third edition-secondary publication. J Orthop Sci, 2022, 27(1): 31-78.
3. 中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会, 骨科康复学组. 腰椎间盘突出症诊疗指南. 中华骨科杂志, 2020, 40(8): 477-487.
4. Vialle LR, Vialle EN, Suárez Henao JE, et al. Lumbar disc herniation. Rev Bras Ortop, 2015, 45(1): 17-22.
5. Long DM, BenDebba M, Torgerson WS, et al. Persistent back pain and sciatica in the United States: patient characteristics. J Spinal Disord, 1996, 9(1): 40-58.
6. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 2009, 12(4): 699-802.
7. van den Hout WB, Peul WC, Koes BW, et al. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ, 2008, 336(7657): 1351-1354.
8. Peul WC, van den Hout WB, Brand R, et al. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ, 2008, 336(7657): 1355-1358.
9. Mixter WJ, Barr JS. Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med, 1934, 211: 210-214.
10. Love GJ, Walsh MN. Protruded intervertebral disks report of one hundred cases in which operation was performed. JAMJ, 1938, 111(5): 396-400.
11. Hijikata S, Yamagishi M, Nakayama T, et al. Percutaneous nuclectomy: A new treatment method for lumbar disc herniation. Toden Hosp, 1975, 5(1): 5-13.
12. Yasargil MG. Microsurgical operation of herniated lumbar disc//R. Wüllenweber, et al. Lumbar Disc Adult Hydrocephalus. Berlin Heidelberg: Springer-Verlag, 1977: 81.
13. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
14. Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J, 2002, 2(1): 41-48.
15. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
16. Yang JS, Chu L, Chen CM, et al. Foraminoplasty at the tip or base of the superior articular process for lateral recess stenosis in percutaneous endoscopic lumbar discectomy: A multicenter, retrospective, controlled study with 2-year follow-up. Biomed Res Int, 2018, 2018: 7692794. doi: 10.1155/2018/7692794.
17. Lee CH, Choi M, Ryu DS, et al. Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: A meta-analysis. Spine (Phila Pa 1976), 2018, 43(24): 1756-1764.
18. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
19. Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
20. Ding W, Yin J, Yan T, et al. Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation. Orthopade, 2018, 47(7): 574-584.
21. Ito Z, Shibayama M, Nakamura S, et al. Clinical comparison of unilateral biportal endoscopic laminectomy versus microendoscopic laminectomy for single-level laminectomy: A single-center, retrospective analysis. World Neurosurg, 2021, 148: e581-e588.
22. Jiang HW, Chen CD, Zhan BS, et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res, 2022, 17(1): 30. doi: 10.1186/s13018-022-02929-5.
23. Lee JK, Amorosa L, Cho SK, et al. Recurrent lumbar disk herniation. J Am Acad Orthop Surg, 2010, 18(6): 327-337.
24. Li Z, Yang H, Liu M, et al. Clinical characteristics and risk factors of recurrent lumbar disk herniation: A retrospective analysis of three hundred twenty-one cases. Spine (Phila Pa 1976), 2018, 43(21): 1463-1469.
25. Pan M, Li Q, Li S, et al. Percutaneous endoscopic lumbar discectomy: Indications and complications. Pain Physician, 2020, 23(1): 49-56.
26. Wang H, Zhou Y, Li C, et al. Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy. J Neurosurg Spine, 2015, 23(3): 320-325.
27. 刘雅普, 高利峰, 徐永辉, 等. 经皮经椎间孔入路内镜下椎间盘切除术治疗腰椎间盘突出症术中并发类脊髓高压症的临床研究. 中国脊柱脊髓杂志, 2019, 29(4): 382-384.
28. Joh JY, Choi G, Kong BJ, et al. Comparative study of neck pain in relation to increase of cervical epidural pressure during percutaneous endoscopic lumbar discectomy. Spine (Phila Pa 1976), 2009, 34(19): 2033-2038.
29. Guan X, Wu X, Fan G, et al. Endoscopic retrieval of a broken guidewire during spinal surgery. Pain Physician, 2016, 19(2): E339-E342.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation

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