Clinical comparison of percutaneous endoscopic lumbar discectomy and posterior lumbar interbody fusion for L4/5 and L5/S1 dual-level disc herniation

This was a retrospective study. The present study investigates whether Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach(PELD) is no less effective than posterior lumbar interbody fusion(PLIF) in the treatment of L4/5 and L5/S1 two-level disc herniation. In this retrospective study, we included 40 patients with L4/5 and L5/S1 two-level lumbar disc herniation (LDH) who received PELD (n = 18) or PLIF (n = 22). The two groups are divided into a united group(PELD) and a fusion group(PLIF). In the united group, the transforaminal approach was adopted for L4/5 level disc herniation, and the interlaminar approach was adopted for L5/S1 level disc herniation. The degree of nerve root and dural compression determined by MRI was taken preoperatively. The clinical outcomes which preoperative 1 week, 3 months,6 months,12 months, 24 months, 36months and final follow-up after surgery between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), the Japanese Orthopaedic Association (JOA) and the modified MacNab criteria. In both groups, the VAS, ODI and JOA scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05). According to the modified MacNab criteria, the excellent or good outcome rate was 94.44% in the united group and 90.91% in the fusion group. Within 1 week after the operation, there was a significant difference in the improvement of clinical symptoms between the combination group and the fusion group (P < 0.05), and the combination group was better than the fusion group. Additionally, within three months postoperatively, the combination group exhibited significantly better functional improvements compared to the fusion group .With the gradual recovery of patients, there was no significant difference in the improvement of clinical symptoms between the two groups (P > 0.05). To sum up, This study aimed to compare the efficacy of PELD and PLIF in the treatment of dual-segmental lumbar disc herniation of L4/5 and L5/S1. Compared with PLIF, PELD has advantages in less intraoperative bleeding, shorter operation time and non-general anesthesia. However, the possibility of postoperative recurrence of PLIF is lower. In short, both methods can bring satisfactory results to patients. Clinically, surgeons should carefully weigh the advantages and disadvantages of the two operations and choose the operation method suitable for patients. At the same time, in future studies, we should further extend the follow-up time to observe whether vertebral fusion has more advantages in preventing postoperative recurrence.