Elsevier

World Neurosurgery

Volume 112, April 2018, Pages e255-e260
World Neurosurgery

Original Article
Comparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up

https://doi.org/10.1016/j.wneu.2018.01.030Get rights and content

Highlights

  • This work aimed to compare the surgical outcome of minimally invasive endoscopic discectomy and percutaneous endoscopic lumbar discectomy for the treatment of adolescent lumbar disc herniation.

  • Minimally invasive endoscopic discectomy and percutaneous endoscopic lumbar discectomy are both effective surgical method for the treatment of adolescent lumbar disc herniation.

  • Percutaneous endoscopic lumbar discectomy is superior to minimally invasive endoscopic lumbar discectomy in short term, but in the long run, they receive an equal surgical outcome.

Objective

To compare the efficacy and safety of minimally endoscopic discectomy (MED) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of adolescent lumbar disc herniation (ALDH).

Methods

We retrospectively collected data from 30 patients with ALDH who underwent MED and 48 patients with ALDH who underwent PELD at our hospital between January 2010 and January 2012. Baseline data included age, sex, symptom duration, and surgical segment. Perioperative data included duration of surgery duration, blood loss, and duration of postoperative hospitalization. The Oswestry Disability Index (ODI) and visual analog scale (VAS) for both the lower back and leg were recorded as surgical outcomes. All surgical outcomes were recorded before surgery, at 1 week after surgery, at 6 months after surgery, and at final follow-up.

Results

There were no significant differences in baseline data between the MED and PELD groups. Both groups showed improvements in ODI and VAS scores before surgery and at the final follow-up time point (P < 0.05); however, the MED group had a higher mean ODI score at 1 week (12.44 ± 6.39 vs. 7.25 ± 6.40; P = 0.02) and 6 months (9.33 ± 7.43 vs. 3.97 ± 7.64; P = 0.04) after surgery. In addition, mean VAS scores for lower back pain were higher in the MED group at 1 week (1.93 ± 1.39 vs. 0.91 ± 0.85; P = 0.01), 6 months (1.80 ± 1.15 vs. 0.61 ± 0.94; P = 0.00), and final follow-up (1.87 ± 1.46 vs. 0.65 ± 0.88; P = 0.00), as was mean VAS score for radicular pain at 1 week after surgery (1.48 ± 0.76 vs. 0.74 ± 0.81; P = 0.01). One patient in each group experienced recurrent lumbar disc herniation. No other complications were reported in either group.

Conclusions

Both PELD and MED are effective and safe surgical techniques for the treatment of ALDH; however, compared with MED, PELD is more advantageous for lower back pain and provides more rapid resolution of radicular pain.

Introduction

Adolescent lumbar disc herniation (ALDH) constitutes 0.6%–6.8% of all cases of lumbar disc herniation (LDH).1, 2 Gulati et al.3 used data from the Norwegian Registry for Spine Surgery to compare the efficacy and safety of microdiscectomy in adolescents and adults with LDH and found similar surgical outcomes and complication rates in the 2 groups.3 To date, however, minimally invasive methods have not been reported for the treatment of patients with ALDH.

Microendoscopic discectomy (MED), one of the prevailing surgical techniques for the treatment of LDH, was first described by Foley and Smith in 19974 and is becoming increasingly popular among spine surgeons. Numerous studies have confirmed its effectiveness and safety even when used to treat recurrent lumbar disc herniation.5, 6, 7 One meta-analysis on the efficacy and safety of MED concluded that the procedure provides long-term improvement in leg pain equivalent to that from open discectomy; however, the analysis did not evaluate the efficacy of MED in relieving lower back pain.8

Percutaneous endoscopic lumbar discectomy (PELD) was first described by Yeung et al.9 in 2002, and soon attracted the attention of many spine surgeons. In a 10-year follow-up study, Eun et al.10 found that PELD can effectively resolve both lower back pain and radicular pain with no disc height loss. Yoon et al.11 reported similar clinical outcomes and low complication rates in patients who underwent MED and those who underwent PELD.

To date, however, no study has explored the surgical outcomes of patients with ALDH. Here we report a 5-year retrospective follow-up of patients with ALDH who underwent MED or PELD at our hospital, focusing on outcomes and safety of the 2 procedures.

Section snippets

Patients

We retrospectively reviewed patients age <21 years with LDH who were treated in our department between January 2010 and January 2012. The patients were screened using history and physical examination findings, and the diagnosis of ALDH was confirmed by lumbar disc magnetic resonance imaging. The inclusion criteria were (1) diagnosis of LDH with no improvement after 6–8 weeks of conservative treatment, (2) age <21 years, (3) surgery with either MED or PELD, and (4) surgery performed by a senior

Results

A total of 80 patients met our criteria and were enrolled in our study. As a result, 30 cases and 48 cases were analyzed for the MED and PELD groups, respectively. The numbers of surgery for each involved surgeons were shown in Table 1. The mean duration of follow-up was 67.07 ± 6.76 months in the MED group and 68.87 ± 7.03 months in the PELD group. There were no significant between-group differences in age, sex, and body mass index (P > 0.05) (Table 2).

Perioperative data, including duration of

Discussion

Our findings indicate that both MED and PELD are effective treatments for ALDH. After surgery, patients from both groups reported less lower back and leg pain, as well as improved quality of life. The patients in the MED group reported more severe lower back pain. PELD provided superior leg pain relief at 1 week after surgery, but long-term pain relief was similar in the 2 procedures.

Adolescent was a special group with several characteristics. First, the structure of the intervertebral disc

Conclusions

In this midterm retrospective study, we found that PELD and MED provided equivalent relief of radicular pain and improved quality of life in the short term for adolescents with ALDH, but PELD was more advantageous for lower back pain.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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