Introduction: Percutaneous endoscopic discectomy (PELD) is an effective treatment to relieve leg pain symptom for patients with lumbar disc herniation (LDH). Yet, effects of PELD on back pain and life quality in LDH patients remain unknown. This study aimed to evaluate therapeutic efficacy of PELD in treating back pain symptom in LDH patients and determine associated clinical factors.
Methods: This is a prospective study. From January 2018 to December 2022, all patients with a single-level symptomatic LDH who underwent PELD at author’s institution were studied. Demographic information, clinical characteristics, and magnetic resonance (MR) findings, including endplate defects and Modic changes were evaluated 1 day before PELD procedure. Back pain and quality of life was evaluated using numerical rating scale (NRS) and Roland Morris Disability Questionnaire (RMDQ), respectively. Data were collected preoperatively, and 1, 3, 6, and 12 months after PELD surgery. The primary outcome was clinically significant improvements in back pain and quality of life at 12-month follow-up, which were defined as a minimal of 30% decrease from baseline. Data analyses were used t-tests and logistic regression.
Results: During the defined period, a total of 538 surgical patients of LDH were studied. There were 340 men and 198 women, and the age was 42.89±13.46 years. While most (56.7%) patients had mild back pain (NRS≤3) before surgery, 32.3% and 11.0% of patients suffered from moderate and severe back pain, respectively. Approximately half of herniated discs had endplate defects and Modic changes on cranial or caudal endplate. Under endoscopy, 29.9% of patients had avulsed cartilage fragment and 22.9% had disc calcification. Overall, 51.5% and 55.0% patients had clinically meaningful relieve of back pain at 1-month and 12-month follow-up, respectively. A substantial reduction in back pain was observed at one month (3.29 Insignificant improvement in back pain after PELD was associated with age (OR=2.08, 95%CI [1.10-3.94], P=0.02), the presence of MCs (OR=2.49, 95%CI [1.15-5.41], P=0.02), cartilaginous avulsion (OR=2.21, 95%CI [1.05-4.68], P=0.04) and pre-operative pain intensity (OR=0.22, 95%CI [0.12-0.40], P=0.01). There were 68.5% and 87.5% patients had significant improvement in quality of life at 1-month and 12-month follow-up, respectively. Life quality was significantly improved after surgery, as revealed by a significantly reduction of RMDQ (13.94±5.65 vs 3.16±4.10, P<0.001) at 12 months follow-up. Insignificant improvement in quality of life was associated with age (OR=2.56, 95%CI [1.06-6.20], P=0.04), lumbosacral transitional vertebra (OR=2.33, 95%CI [1.03-5.25], P=0.04).
Discussion: After PELD, approximately a half of LDH patients had significant relieve of back pain, while the majority of patients had significant improvement in life quality. Age, Modic changes, and cartilaginous avulsion were associated with inferior relieve in back pain, and age and lumbosacral transition were associated with inferior improvement in quality of life in treating LDH using PELD.
Key words: Lumbar disc herniation (LDH), Percutaneous endoscopic discectomy (PELD), Back pain, Life quality, Clinical improvement