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[Diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery].

OBJECTIVE
To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery.


METHODS
From December 2009 to June 2010, 119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia. There were 75 males and 44 females with a mean age of 44.8 years (range: 15 - 55). The mean disease course was 9 months (range: 3 - 72). The major symptoms were back pain and/or unilateral sciatica. The mean follow-up period was 26 months. All underwent lumbar radiography, computed tomography (CT) and magnetic resonance imaging (MRI) revealing 112 single level and 7 two-level disc herniations. There were 82 lateral and 37 para-medial disc herniations. Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolisthesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Precise orientation and operation was performed under the guidance of pre-operative imaging, intra-operative fluoroscopy or CT and endoscopic exploration.


RESULTS
Among them, 117 cases had the surgery performed successfully. The mean operative duration was 85 min (range: 35 - 85) and the mean blood loss 13 ml (range: 1 - 50). One patient had L5 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months. Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter. Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically. No one had a conversion into open surgery. They were followed up for a mean period of 26.1 months (range: 25 - 27). Five patients lost follow-up. VAS improved statistically significantly from preoperative 6.8 to postoperative 1.8 (P < 0.05). ODI decreased from preoperative 70.06 to 19.09 at the last follow-up. The Macnab results were excellent (n = 82, 68.9%), good (n = 20, 16.7%), fair (n = 8, 6.7%) and bad (n = 9, 7.7%) (including all patients lost to follow-up). And the excellent-to-good rate was 85.6%.


CONCLUSION
With fewer complications and a low recurrence rate, percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.