1. 2021;24;E877-E882Pain Variability of Tissues Under Endoscope in Percutaneous Endoscopic Lumbar Discectomy and Its Significance: A Retrospective Study
   Retrospective Study
   Cheng Su, MD, Xiaoyang Liu, MD, Jun Xin, MD, Feifei Chen, MD, and Xingang Cui, MD.

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research.

OBJECTIVES: The purpose of the study is to evaluate tissue pain variability during PELD as for the treatment of LDH, to provide references and guideline for the operation, and to give humanistic care for patients.

STUDY DESIGN: A retrospective analysis.

SETTING: All data were collected from Shandong Provincial Hospital Affiliated to Shandong First Medical University.

METHODS: From January 2008 to December 2020, 3,600 patients with LDH were enrolled in this retrospective study. All patients suffered from low back and leg pain because of LDH and underwent PELD. The pain of these tissues under endoscope was assessed according to the Visual Analog Scale (VAS) scores for the back and legs (VAS-B and VAS-L, respectively).

RESULTS: For VAS-B, the tissues were ranked from the highest VAS scores to the lowest in the following order: posterior longitudinal ligament; next, dural sac/nerve root; then, endplate/annulus fibrosus/ligamentum flavum. For VAS-L, they were in the following order: dural sac/nerve root; next, posterior longitudinal ligament; then, endplate/annulus fibrosus/ligamentum flavum.

LIMITATIONS: Retrospective nature of data collection.

CONCLUSIONS: Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH.

KEY WORDS: Percutaneous endoscopic lumbar discectomy, visual analog scale, lumbar disc herniation, pain