The Strategy of Percutaneous Endoscopic Lumbar Discectomy for Treating 4/5 Lumbar Intervertebral Disc Herniation

［Abstract］Objective　To discuss the surgical strategy and clinical effect of PELD（Percutaneous endoscopic lumbar discectomy）in treatment of Lumbar intervertebral disc herniation. Methods From August to October in 2013，200 patients with L4-L5 Lumbar intervertebral disc herniation were selected to be treated by PELD. There were 124 male patients and 76 female patients. All of the patients with the average age of 41 were suffering from obvious pain in waist and lower extremities. Under local anesthesia and monitoring of radiography，and with an admission passage from shoulder and axillary region， nucleus pulposus removal was finished by the means of percutaneous endoscope. VSA（Visual Analogue Scale）and ODI（Oswestry Disability Index）were used to evaluate the clinical effect. Results　The follow-up visit to 196 patients lasted for 9-24 months in which the average time was 13.5 months. The VSA of preoperative pain in waist and lower extremities was（7.5±1.8）. After operation， the VSA of the pain after 3 months was（3.0±1.5）， the VSA of the pain after 6 months was（2.8±1.3），and the VSA of the pain after 12 months was（2.0±1.5）. There were obvious differences between before operation and after operation （P＜0.01）；before operation，ODI was（58.5±17.8）%， while after operation， ODI was（29.3±10.5）% after 3 months，（20±7.5）% after 6 months，（15.6±6.4）% after 12 months. There were obvious differences between before operation and after operation（P＜0.01）. Conclusions　Percutaneous endoscopic treatment of 4/5 lumbar intervertebral disc herniation from shoulder and axillary region is very complete and effective. Selecting patients correctly before operation and adequate radiology evaluation are the key to guaranteeing surgical success.