Efficacy analysis of different approaches of percutaneous transforaminal endoscopic local anesthesia in the treatment of L5- S1 disc herniation

Background: Both transforaminal and interlaminar approaches are effective methods for the treatment of L5-S1 disc herniation. Few studies have compared the efficacy and complications of two approaches under local anesthesia in the treatment of L5-S1 disc herniation Methods: From May 2018 to July 2021, 72 patients with L5-S1 disc herniation were randomized to the transforaminal endoscopic lumbar discectomy (TELD, n = 36) or interlaminar endoscopic lumbar discectomy (IELD, n = 36). Both procedures were performed under 1% lidocaine local anesthesia. The baseline data, puncture time, radiation time, operative time unde the endoscope, total operation time, hospitalization time, bed rest time, and complications were compared between the two groups. In addition, Likert five-point scale was used for evaluation of patients experience to local anesthesia and tolerance to re-operation was assessed as well. The efficacy of surgery was assessed according to Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab score. Results: All patients with an average follow-up of 27.5 months. Compared to the IELD group, the TELD group had a longer puncture time (15.31±2.53>5.11±1.67, P < 0.001) and radiation time (8.44±2.01>4.61±1.27, P < 0.001) but a shorter total operative time(52.22±5.44<58.53±0.69, P=0.001) , operative time unde the endoscope(36.92±5.79<53.42±9.60, P < 0.001) and lower VAS scores for intraoperative back pain (P < 0.001) and leg pain (P<0.001). The postoperative VAS score and ODI score in both groups were significantly lower than those before operation(P<0.001), and there was no significant difference for each data collection time between the two groups (P > 0.05). The postoperative survey showed that the satisfaction rate of TELD group was higher than that of IELD group(P=0.026), TELD group was superior to IELD group in tolerance to re-operation(P =0.007). According to MacNab criteria, the excellent and good rate rates of TELD group and IELD group were 93.3% and 90.0%, and the difference was not statistically significant (P > 0.05). Conclusion: For L5/S1 DH, Both TELD and IELD can achieve good clinical efficacy under local anesthesia. Compared with PETD, PEID had lower puncture time, total operation time, and radiation exposure, but higher incidence of intraoperative low back pain and patients satisfactory rates less.