Improvement in Radicular Pain after Endoscopic Transforaminal Lumbar Discectomy at Discs with Advanced Degenerative Changes

Abstract

Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation.

Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p < 0,05.

Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2–L3 1 (2%), L3–L4 2 (4%), L4–L5 9 (18%), L5–S1 8 (16%), L3–L4 + L4–L5 4 (8%), and L4–L5 + L5–S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group (p < 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V).

Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.

Keywords

sciatica - intervertebral disc displacement - lumbosacral region

Study developed at the Postgraduate Course in Minimally Invasive Spine Surgery of the School of Medicine of the Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Publication History

Received: 12 September 2020

Accepted: 11 February 2021

Article published online:
13 October 2021

• Referências

• 1 Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation. Int J Spine Surg 2017; 11 (04) 28-40
• 2 Gadjradj PS, van Tulder MW, Dirven CM, Peul WC, Harhangi BS. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series. Neurosurg Focus 2016; 40 (02) E3-E9
• 3 Wu J, Zhang C, Zheng W, Hong CS, Li C, Zhou Y. Analysis of the Characteristics and Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniation. World Neurosurg 2016; 92: 142-147
• 4 Jiang X, Zhou X, Xu N. Clinical effects of transforaminal and interlaminar percutaneous endoscopic discectomy for lumbar disc herniation: A retrospective study. Medicine (Baltimore) 2018; 97 (48) e13417-e13422
• 5 Li Y, Wang B, Wang S, Li P, Jiang B. Full-Endoscopic Decompression for Lumbar Lateral Recess Stenosis via an Interlaminar Approach versus a Transforaminal Approach. World Neurosurg 2019; 128: e632-e638
• 6 Falavigna A, Teles AR, Braga GL, Barazzetti DO, Lazzaretti L, Tregnago AC. Instrumentos de Avaliação Clínica e Funcional em Cirurgia da Coluna Vertebral. Coluna/Columna 2011; 10 (01) 62-67
• 7 Oliveira JAA, Guerra e Silva VT. Almeida, LEPCAd, Meireles RdSP, Lopes GdR, Mello APd, Almeida PC, Silva LECTd. T1 pelvic angle in improvement of pain in high-grade lumbar spondylolisthesis. Coluna/Columna 2020; 19 (02) 108-111
• 8 Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J 2016; 25 (01) 134-143
• 9 Pan M, Li Q, Li S. et al. Percutaneous Endoscopic Lumbar Discectomy: Indications and Complications. Pain Physician 2020; 23 (01) 49-56
• 10 Ruetten S, Komp M. Endoscopic Lumbar Decompression. Neurosurg Clin N Am 2020; 31 (01) 25-32
• 11 Xu J, Li Y, Wang B. et al. Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation with Modic Changes via a Transforaminal Approach: A Retrospective Study. Pain Physician 2019; 22 (06) E601-E608
• 12 Zhou C, Zhang G, Panchal RR. et al. Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy. Pain Physician 2018; 21 (02) E105-E112
• 13 Park CH, Park ES, Lee SH. et al. Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression. Pain Physician 2019; 22 (02) E133-E138