Application of the repeated foraminoplasty in percutaneous endoscopic transforaminal discectomy for lumbar disc herniation patients with lumbar foraminal stenosis

Background: A sufficient foraminoplasty is critical in percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH), which may affect the progress of surgery. This study assessed the repeated foraminoplasty applicated in PETD for LDH patients with lumbar foraminal stenosis (LFS).

Methods: 133 LDH patients with LFS who underwent PETD were enrolled in this study, which were segregated into the traditional foraminoplasty group (TF group) and the repeated foraminoplasty group (RF group). The intervertebral foramen enlargement and the ratio of nerve roots completely exposed were compared between two groups. Some perioperative indicators were assessed for the surgical efficiency and safety. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score and MacNab criteria were used to evaluate patients' clinical outcomes.

Results: The anteroposterior diameter (APD) increasement of intervertebral foramen(P<0.001) and the ratio of the nerve roots completely exposed (P=0.032) in the RF group were significantly greater than those in the TF group. The decompression time and total surgery time of the patients who performed RP were significantly shorter than those who performed TP (P<0.001). With respect to the clinical efficacy evaluation, the VAS score of leg pain in the TF group was greater than that in the RF group only on the first day postoperatively (P=0.031).

Conclusion: Repeated foraminoplasty applicated in PETD for the LDH patients with LFS might improve the intervertebral foramen enlargement in APD, nerve roots exposure, operation efficiency and the immediate relief of leg pain after surgery.