2020 Volume 11 Issue 8 Pages 1010-1015
Objective: The purpose of this study was to evaluate the outcome of FELD with FEL (FEL) and transforaminal FELD (FELD TF) for lumbar disc herniation with canal stenosis (LDH with LCS).
Method: From July 2015 to June 2018, we analyzed the severity of canal stenosis in MRI, type of neurological symptoms, operation time, visual analog scale (VAS) of pre and post operation and Macnab criteria for LDH with LCS patients. FEL was performed under general anesthesia. On the other hand, FELD TF was done by transforaminal approach under local anesthesia.
Results: The results were mentioned in order of FEL:FELD TF. 27 (16 male and 11 female):59 (36 male and 23 female) patients met the inclusion criteria. Mean age was 73.2:64.3 years. Mean follow up periods was 13.4:11.8 months. In MRI, severe stenosis was 14:6, moderate was 12:39, mild was 1:14 patients. 17:41 patients had unilateral and 10:18 patients had bilateral neurological symptoms. Mean operation time was 67.5:34.0 minutes (p < 0.05). Preoperative VAS scores of low back pain were 63.4:58.6, of leg pain were 80.2:75.4 and of numbness were 76.3:68.5. Postoperative VAS scores of low back pain were 37.0:35.7, of leg pain were 39.4:36.9 and of numbness were 47.6:36.3. Mean improvement rates of VAS of low back pain were 41.6:39.1, of leg pain were 50.8:51.0 and of numbness were 37.6:46.9%. In MacNab criteria, 19 (70.4%):38 (64.4%) were satisfactory and 2 (0.7%):11 (18.6%) were poor. Postoperative VAS scores of both were significantly lower than preoperative one. Operative time of FELD TF was significantly shorter than that of FEL. In MacNab criteria, poor rate of FELD TF was higher than that of FEL. In 10 patients with poor results in FELD TF, 5 patients had stenosis and 4 had herniation.
Conclusion: FELD TF was less invasive surgery, but functional outcomes were inferior, so we should choose it carefully.
