EVALUATION OF CLINICAL OUTCOMES OF PRIMARY PERCUTANEOUS ENDOSCOPIC TRANSFORMATIVE DISCECTOMY

Abstract. Introduction. Percutaneous transforaminal endoscopic surgery for lumbar intervertebral disc herniation is comparable in efficacy to traditional posterior open discectomy and microdiscectomy. However, in some cases, limited intraoperative margins can lead to incomplete removal of the herniated disc and incomplete decompression of the neural structures. This can lead to unfavorable PETD results. Therefore, identifying the factors that may influence the outcome of endoscopic transforaminal discectomy is crucial. Aim. To determine the clinical factors influencing the outcome of primary percutaneous endoscopic transforaminal discectomy of lower lumbar intervertebral disc herniations based on a comparative retrospective analysis of favorable and unfavorable treatment outcomes. Materials and methods. Materials: clinical and radiological examination protocols of 102 patients aged 34-68 years, who underwent primary PETD for isolated herniated disc of the lower lumbar spine in the period 2015-2024. Based on the PETD results, the patients were divided into 2 groups: group I (87%) with favorable consequences; group II (13%) - with unfavorable treatment results. Methods: 1) follow-up data; 2) clinical: orthopedic status, pain intensity according to the visual analogue scale VAS in the lumbar spine and lower limb, Oswestry disability index were determined before and 1 day, 3 months and 6 months after surgery; 3) statistical. Results. The duration of the hernia follow-up in months and the period between the onset of the hernia and the performance of the primary PETD in months were almost identical in Groups I and II. In Group I, lumbar spine mobility increased during the postoperative period according to the Schober test; at 3 and 6 months after surgery, it was significantly higher than the preoperative data (p<0.01) and the results in Group II (p<0.05 and p<0.01, respectively). In Group I, the number of negative Lasegue test results significantly increased (for Lasegue 2 and 3 p<0.01; Lasegue 4 p<0.001); in Group II, there was a clear trend towards an increase in the frequency of positive tests and a decrease in the frequency of negative tests during the preoperative examination (Lasegue 1) and the absence of negative tests at 3 and 6 months after surgery (Lasegue 3 and 4). A significant decrease in radiculalgia was found according to the VAS score throughout the postoperative period compared to the preoperative data: 1 day after PTED, p<0.05; after 3 months, p<0.01; after 6 months, p<0.001. In group II, the intensity of radiculalgia decreased insignificantly during the postoperative period and was significantly lower at 3 and 6 months after surgery compared to group I (p<0.05 and p<0.001, respectively). Almost the same patterns were found in the analysis of the ODI disability index according to the Oswestry questionnaire. Conclusion. An unfavorable outcome of primary PETD is characterized by the absence of positive dynamics during the postoperative period (up to 6 months after PETD) in terms of a decrease in myofixation of the trunk, a decrease in the intensity of radiculalgia and the level of disabilitation, self-assessment of the result of surgical treatment according to the modified McNab scale as «satisfactory» and «unsatisfactory».