Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L<sub>5</sub>, S<sub>1</sub> lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 GAO Hangfei ¹ , GUI Jiancao ² , JIANG Yiqiu ² , XU Yan ² , XU Bo ¹ , XIONG Mingyue ¹ , CUI Yongguang ¹

1. Department of Traumatology, the First Affiliated Hospital of Henan University of Science & Technology, Luoyang Henan, 471000, P.R.China;
2. Department of Orthopedics, Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;

Corresponding author：

GAO Hangfei, Email: anyiyi1@126.com

Keywords：

Ilium height; percutaneous endoscopic lumbar discectomy; lumbar disc herniation; ilium height rate; ilium angle rate; quantitative index

DOI：

10.7507/1002-1892.201907021

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Objective To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy (PELD) treatment in patients with L₅, S₁ lumbar disc herniation.Methods A retrospective study between May 2014 and March 2016 was conducted, including 100 patients with disc herniation at L₅, S₁, who were initially enrolled for the PELD treatment. Among them, 66 patients were successfully treated with PELD (group A), and the other 34 patients failed to perform puncture, catheterization, or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans. By analyzing the X-ray films of lumbar vertebrae (including bilateral ilium) of the two groups before operation, the concept of ilium height rate and ilium angle rate was put forward innovatively. The ilium height rate and ilium angle rate of the two groups were measured and compared, and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis.Results The ilium height rate was 0.61±0.09, 0.74±0.05 and the ilium angle rate was 0.66±0.08, 0.80±0.08 in groups A and B, respectively, showing significant differences between the two groups (F=69.729, P=0.000; F=65.165, P=0.000). ROC curve analysis showed that the critical point of ilium height rate was 0.71 (area under ROC curve was 0.927, P=0.000), and the critical point of ilium angle rate was 0.75 (area under ROC curve was 0.965, P=0.000).Conclusion PELD is not recommended for patients with L₅, S₁ intervertebral disc herniation, when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75. Other surgical plans such as transpedicular approach, transpedicular approach, or open surgery, should be recommended to reduce the risk of surgery and the pain of patients.

Citation： GAO Hangfei, GUI Jiancao, JIANG Yiqiu, XU Yan, XU Bo, XIONG Mingyue, CUI Yongguang. Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L₅, S₁ lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 157-161. doi: 10.7507/1002-1892.201907021 Copy

1.	Chen Z, Zhang L, Dong J, et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine, 2018, 28(3): 300-310.
2.	Gadjradj PS, Harhangi BS. Percutaneous transforaminal endoscopic discectomy for lumbar disk herniation. Clin Spine Surg, 2016, 29(9): 368-371.
3.	Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol, 2005, 17(6): 641-661.
4.	Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
5.	Nellensteijn J, Ostelo R, Bartels R, et al. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: asystematic review of the literature. Eur Spine J, 2010, 19(2): 181-204.
6.	陈之光, 付勤. 椎间孔镜经不同入路治疗腰椎间盘突出症的临床进展. 中国骨伤, 2012, 25(12): 1057-1060.
7.	Liu X, Yuan S, Tian Y, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine, 2018, 28(3): 317-325.
8.	Song HP, Sheng HF, Xu WX. A case-control study on the treatment of protrusion of lumbar intervertebral disc through PELD and MED. Exp Ther Med, 2017, 14(4): 3708-3712.
9.	李长青, 周跃, 王建, 等. 经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症. 中国脊柱脊髓杂志, 2013, 23(3): 193-197.
10.	镐英杰, 刘涛, 于磊, 等. 经皮椎间孔镜联合 Coflex 棘突间动力重建系统植入治疗青年腰椎间盘突出症. 中国修复重建外科杂志, 2017, 31(2): 191-196.
11.	杨虎, 李鹏飞, 贾楠, 等. 椎间孔镜不同入路方式对髓核摘除量的影响及临床疗效分析. 中国修复重建外科杂志, 2018, 32(7): 933-940.
12.	Choi KC, Kim JS, Ryn KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6): 547-556.
13.	Ahn Y. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices, 2012, 9(4): 361-366.
14.	Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976), 1984, 9(5): 493-495.
15.	陈崇文, 佟斌, 王宇飞, 等. 腰骶部移行椎的分型及临床意义. 实用骨科杂志, 2013, 19(9): 804-807.
16.	Mirkovic SR, Schwartz DG, Glazier KD. Anatomic considerations in lumbar posterolateral percutaneous procedures. Spine (Phila Pa 1976), 1995, 20(18): 1965-1971.
17.	Abudurexiti T, Qi L, Muheremu A, et al. Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation. J Int Med Res, 2018, 46(9): 3910-3917.
18.	He J, Xiao S, Wu Z, et al. Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J, 2016, 25(5): 1373-1381.
19.	Hubbe U, Franco-Jimenez P, Klingler JH, et al. Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation. J Neurosurg Spine, 2016, 24(1): 48-53.
20.	Li H, Jiang C, Mu X, et al. The comparison of MED and PELD in the treatment of adolescent lumbar disc herniation: A five-year retrospective follow-up. World Neurosurg, 2018, 112: e255-e260.
21.	韩云峰. ROC 曲线下面积的计算方法. 齐齐哈尔医学院学报, 2007, 28(6): 697-698.
22.	Zhou XH, Obuchowski NA, McClish DK. 诊断医学统计学. 宇传华, 译. 北京: 人民卫生出版社, 2005: 13-110.
23.	田俊, 洪金省, 倪倩钰, 等. 应用 ROC 曲线确定心理弹性量表的诊断界值研究. 数学的实践与认识, 2013, 43(6): 165-171.
24.	陈卫中, 倪宗瓒, 潘晓平, 等. 用 ROC 曲线确定最佳临界点和可疑值范围. 现代预防医学, 2005, 32(7): 729-731.

1. Chen Z, Zhang L, Dong J, et al. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine, 2018, 28(3): 300-310.
2. Gadjradj PS, Harhangi BS. Percutaneous transforaminal endoscopic discectomy for lumbar disk herniation. Clin Spine Surg, 2016, 29(9): 368-371.
3. Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol, 2005, 17(6): 641-661.
4. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
5. Nellensteijn J, Ostelo R, Bartels R, et al. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: asystematic review of the literature. Eur Spine J, 2010, 19(2): 181-204.
6. 陈之光, 付勤. 椎间孔镜经不同入路治疗腰椎间盘突出症的临床进展. 中国骨伤, 2012, 25(12): 1057-1060.
7. Liu X, Yuan S, Tian Y, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine, 2018, 28(3): 317-325.
8. Song HP, Sheng HF, Xu WX. A case-control study on the treatment of protrusion of lumbar intervertebral disc through PELD and MED. Exp Ther Med, 2017, 14(4): 3708-3712.
9. 李长青, 周跃, 王建, 等. 经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症. 中国脊柱脊髓杂志, 2013, 23(3): 193-197.
10. 镐英杰, 刘涛, 于磊, 等. 经皮椎间孔镜联合 Coflex 棘突间动力重建系统植入治疗青年腰椎间盘突出症. 中国修复重建外科杂志, 2017, 31(2): 191-196.
11. 杨虎, 李鹏飞, 贾楠, 等. 椎间孔镜不同入路方式对髓核摘除量的影响及临床疗效分析. 中国修复重建外科杂志, 2018, 32(7): 933-940.
12. Choi KC, Kim JS, Ryn KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6): 547-556.
13. Ahn Y. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices, 2012, 9(4): 361-366.
14. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976), 1984, 9(5): 493-495.
15. 陈崇文, 佟斌, 王宇飞, 等. 腰骶部移行椎的分型及临床意义. 实用骨科杂志, 2013, 19(9): 804-807.
16. Mirkovic SR, Schwartz DG, Glazier KD. Anatomic considerations in lumbar posterolateral percutaneous procedures. Spine (Phila Pa 1976), 1995, 20(18): 1965-1971.
17. Abudurexiti T, Qi L, Muheremu A, et al. Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation. J Int Med Res, 2018, 46(9): 3910-3917.
18. He J, Xiao S, Wu Z, et al. Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J, 2016, 25(5): 1373-1381.
19. Hubbe U, Franco-Jimenez P, Klingler JH, et al. Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation. J Neurosurg Spine, 2016, 24(1): 48-53.
20. Li H, Jiang C, Mu X, et al. The comparison of MED and PELD in the treatment of adolescent lumbar disc herniation: A five-year retrospective follow-up. World Neurosurg, 2018, 112: e255-e260.
21. 韩云峰. ROC 曲线下面积的计算方法. 齐齐哈尔医学院学报, 2007, 28(6): 697-698.
22. Zhou XH, Obuchowski NA, McClish DK. 诊断医学统计学. 宇传华, 译. 北京: 人民卫生出版社, 2005: 13-110.
23. 田俊, 洪金省, 倪倩钰, 等. 应用 ROC 曲线确定心理弹性量表的诊断界值研究. 数学的实践与认识, 2013, 43(6): 165-171.
24. 陈卫中, 倪宗瓒, 潘晓平, 等. 用 ROC 曲线确定最佳临界点和可疑值范围. 现代预防医学, 2005, 32(7): 729-731.

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Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L₅, S₁ lumbar disc herniation

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Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L5, S1 lumbar disc herniation

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Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L₅, S₁ lumbar disc herniation