Endoscopic unilateral versus bilateral decompression effects on lumbar disc herniation with contralateral symptoms / 中国组织工程研究

ABSTRACT

BACKGROUND: Lumbar disc herniation is mostly accompanied by ipsilateral compression symptoms caused by the pressure of herniated portion on the ipsilateral nerve root. Rare cases are reported to present with contralateral compression symptoms. So there is currently no specific classification and nomenclature for this type of lumbar disc herniation, which is referred to as lumbar disc herniation with contralateral symptoms in this article. OBJECTIVE: To investigate the efficacy of endoscopic lumbar nucleus pulposus removal for unilateral versus bilateral decompression in patients with lumbar disc herniation presenting with contralateral symptoms. METHODS: Forty patients with contralateral symptomatic lumbar disc herniation who underwent endoscopic lumbar nucleus pulposus surgery from January 2015 to December 2018 were enrolled in enrolled for retrospective analysis. According to the different decompression methods, the patients were randomly divided into an ipsilateral decompression group (n=20) and a bilateral decompression group (n=20). The visual analogue scale (VAS) and Japanese Orthopedics Association (JOA) scores of the lumbar and lower extremities before and at 3, 6, and 12 months after surgery were recorded. Clinical efficacy was evaluated by the modified Macnab standard at 12 months after surgery. Dynamic X-rays of the lumbar spine were used to evaluate lumbar stability. RESULTS AND CONCLUSION: All the 40 patients were followed up for 12-20 months, with an average of 16 months. There were no complications such as dural sac tear and intervertebral space infection in the two groups. The pain in the lower back and lower extremities were significantly relieved in both groups. The postoperative JOA score was significantly higher than that before surgery; and the postoperative VAS scores of the waist and lower extremities were significantly lower than those before surgery (P < 0.05). The VAS and JOA scores in the bilateral decompression group were significantly superior to those in the unilateral decompression group (P < 0.05). The improved Macnab evaluation at 12 months after surgery showed that the excellent and good rate was 70% in the unilateral decompression group, and 95% in the bilateral decompression group, with significant difference between two groups (P < 0.05). Lumbar spine dynamic X-rays at 12 months after surgery showed no lumbar instability or slippage in the two groups. For patients with lumbar disc herniation presenting with contralateral symptoms who underwent percutaneous transforaminal lumbar nucleus pulposus removal, pain symptoms eased off after treatment with two decompression methods, but the bilateral decompression had better postoperative recovery compared with the unilateral decompression.