Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation

• Published in: The journal of spinal cord medicine 2020-01, Vol.43 (1), p.46-52
• Main Authors: Kim, Seung-Kook, Lee, Su-Chan, Park, Seung-Woo
• Format: Article
• Language: English
• Subjects: Adult; Decompression, Surgical; Disability Evaluation; Diskectomy; Endoscopic spine surgery; Endoscopic surgical procedure; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral disc displacement; Intervertebral Disc Displacement - diagnostic imaging; Intervertebral Disc Displacement - surgery; Laser surgery; Lasers; Lumbosacral Region - surgery; Male; Middle Aged; Minimally invasive surgery; Pain Measurement; Return to Work
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1080/10790268.2018.1442285

Context/Objective: Trans-sacral epiduroscopic laser decompression (SELD) is an alternative to microscopic open lumbar discectomy (OLD). SELD and OLD for L5-S1 lumbar disc herniation (LDH) have not been compared. We compared clinical results, including pain control, between SELD and OLD. Design: Retrospective analysis. Setting: Korean hospital. Participants: Eighty patients treated with SELD (n = 40) or microscopic OLD (n = 40) for L5-S1 LDH. Interventions: N/A. Outcome Measures: Clinical data were compared over 6 months. Functional status was evaluated using Oswestry Disability Index (ODI, 0-100%) and time to return to work. Preoperative and postoperative pain was measured using a visual analog scale (VAS, 0-10). Radiological assessment was performed preoperatively and postoperatively. Results: The ODI and VAS scores for leg and back pain significantly improved in both groups. At 6-months after the procedure, the average ODI decreased to 13.2 ± 11.2 from 54.5 ± 14.5 for SELD and 9.5 ± 10.4 from 57.5 ± 16.0 for OLD. The average leg VAS decreased to 1.9 ± 1.2 from 6.0 ± 1.4 for SELD and 2.3 ± 1.3 from 6.7 ± 1.6 for OLD. Back VAS reduced to 2.6 ± 1.3 from 7.2 ± 1.5 for OLD. Time to return to work was 1.1 ± 1.1 weeks for SELD and 5.4 ± 2.1 weeks for OLD. Clinical outcomes of SELD were non-inferior to those of OLD in terms of pain control. Conclusion: A scar-free procedure and early return to normal life are advantages of SELD.