Background: Although minimally invasive has been adopted in the treatment of lumbar disc herniation, there were no studies in literature of two-level lumbar disc herniations patients with leg pain and numbness treatment by one portal percutaneous endoscopic procedures. The purpose of this study was to evaluate the efficacy of one percutaneous portal transforaminal endoscopic lumbar discectomy techniques in the treatment of two-level lumbar disc herniations patients with leg pain and numbness.
Methods: A total of 98 patients of two-level lumbar disc herniations who had one portal endoscopic surgery were categorized into two groups depending on the level number of endoscopic procedures. There were 51 patients had leg pain and leg numbness (A group), and 47 patients with leg pain (B group). One portal percutaneous endoscopic discectomy procedures were performed and the clinical outcomes were recorded.
Results: The entry point of two levels disc herniations is planned by parallel to the plane of the proximal disc level and target to the site of distal disc herniation. The procedures in two levels disc herniations was performed beginning at proximal level in L3/4 with L4/5 herniation and distal level in L4/5 with L5/S1. There were no nerve root injury and dural tear of cerebrospinal fluid leakage complications. The postoperative disk and foramen height were no significant difference compare to preoperative in all patients (P > 0.05), and no significant difference between two groups (P > 0.05). The pain index and Oswestry Disability Index score were better than preoperational in all patients, and no significant difference between two groups (P > 0.05). The central disc herniation patients had more leg numbness than lateral disc herniation patients (P < 0.01). For patients with leg pain and leg numbness, the leg numbness release in lateral disc herniation patients were better than central herniation patients, and leg numbness dismissed were 6 months post-operation in lateral herniation patients and 12 months post-operation in central herniation patients
Conclusions: Although two-level disc herniation present a significant challenge for spinal surgeon when adopted single portal techniques of endoscopic discectomy, one percutaneous portal transforaminal endoscopic lumbar discectomy was safe and minimally invasive techniques with faster recovery. For patients with leg pain and leg numbness, the central disc herniation patients had more leg numbness than lateral disc herniation patients, and the leg numbness release in lateral disc herniation patients were better than central herniation patients.