4. Discussion
lumbar herniated, neuronal damage, anxiety/depression, blood loss, acute sciatica pain, postoperative nausea and vomiting, pain, herniations, lower limb pain, acute respiratory failure, Oswestry disability, nerve damage
RECURRENCE, BLOOD LOSS, HERNIATED INTERVERTEBRAL DISC, INTRAOPERATIVE BLOOD LOSS, ACUTE RESPIRATORY FAILURE, COMPLICATIONS
This study aimed to evaluate clinical parameters, including pain intensity, ODI, and EQ-5D-5L scores, in patients with acute sciatica pain before and after endoscopic discectomy in the Slovak and Czech Republic. The study aimed to test the comprehensibility and face validity of EQ-5D-5L scores compared to other health measurement tools such as the ODI and NRSs for pain.For all patients with LHD in the clinical trial, conservative therapy was initiated after the onset of clinical symptoms for 6 to 8 weeks. This included a combination of steroids, nonsteroidal anti-inflammatory drugs, physical therapy, epidural steroid injections, and rest. If the clinical state did not improve or worsened over time, the treatment strategy was changed to an endoscopic surgical approach. Although there are no proven differences in outcome between conservative and surgical treatment, timely neurosurgical treatment can lead to good long-term results. Nerve decompression performed at the right time is a good prognostic factor for neuronal recovery and can help prevent further irreversible neuronal damage and pain chronification.Among the monitored patients, the majority had a single-level herniated intervertebral disc in the intervertebral spaces L5/S1 (108 patients) and L4/L5 (169 patients). We observed a persistent improvement in the perception of back pain and pain radiating to the lower limbs, with a significant improvement in quality of life 1 year after the follow-up as measured by the EQ-VAS visual scale and the Oswestry disability questionnaire. These findings are consistent with the results of other clinical trials using various surgical approaches for lumbar herniated discs. A systematic review and meta-analysis of 99 articles focused on various spinal conditions found that spine surgery was associated with improved HRQoL for all groups in which postoperative scores were measured. The analysis included 22,312 cases for EQ-5D utilities, 2312 cases for SF-6D utilities, and 11,927 cases for SF-36 PCS scores with a median follow-up time of 12 months. Clinical trials monitoring the treatment of lumbar herniated discs with open surgical approaches, such as hemilaminectomy and microdiscectomy, have also shown the benefit of the procedures and improved patient quality of life after surgery. However, open surgery is associated with disadvantages such as extensive retraction and dissection of paraspinal muscles, longer operating time, larger wounds, and bone resection.A meta-analysis was conducted to compare the effectiveness of open lumbar surgery with lumbar endoscopic discectomy. The analysis included 9 randomized controlled trials with 1092 patients. The results showed that endoscopic surgery had slightly better clinical outcomes than open surgery based on the Macnab criteria, but this difference was not clinically significant. However, patients who underwent endoscopic surgery reported significantly higher satisfaction rates, lower intraoperative blood loss volume, and shorter hospital stays.Similarly, a meta-analysis compared the efficacy of PELD with other surgeries for LDH and demonstrated better outcomes of PELD in 14 clinical trials involving a total of 2528 patients. PELD had a shorter duration of surgery, lower blood loss, and similar complications compared to other surgeries for LDH. However, PELD operations resulted in a higher recurrence rate (relative risk = 1.65, 95% CI: 1.08–2.52; To evaluate the quality of life, we chose the EQ-5D-5L questionnaire as it offers a comprehensive assessment of a patient’s health status. This questionnaire measures 5 dimensions of perceived problems, each with 5 levels of severity, which improves sensitivity and reduces the ceiling effect. The EQ-VAS scale, which is easier to complete and score, was also used. The “Usual activities” dimension evaluates a patient’s performance in work, studying, housework, family, or leisure activities, as well as other dimensions like mobility, self-care, everyday activities, and anxiety/depression. Our analysis shows a significant improvement in the quality of life lasting >1 year after endoscopic surgery (Despite our study involving patients with a mean age of 46.3 years, the clinical improvement, reduction in lower limb pain, and improved quality of life after surgery are consistent with a 2-year follow-up study by Peng et alAn interesting finding from a prospective cohort study by Kapetanakis et alA systematic analysis of clinical trials comparing the effectiveness of transforaminal and interlaminar endoscopic approaches in treating LHD, which reviewed 26 clinical trials involving 3294 patients, demonstrated a significant therapeutic benefit with both interventional approaches. However, the transforaminal approach was associated with higher efficacy, shorter operation time, and lower blood loss.In our clinical study, we selected the safest and most effective possible approach for each patient. For patients with higher levels of L3/4 and L4/5 herniations, we preferred the transforaminal approach. For herniations in the lower spinal segments L5/S1 due to anatomical conditions of the pelvis, we chose the interlaminar approach more often than the transforaminal approach. Comparing both approaches, we did not observe a higher percentage of complications or re-herniation.We consider analgosedation with monitoring as a safe and beneficial method for endoscopic discectomy. It allows for effective communication with the patient, ensuring safety and minimizing the risk of nerve damage. Additionally, it promotes early recovery and a faster return to consciousness, while reducing the occurrence of postoperative nausea and vomiting. Despite potential challenges in airway access, we did not encounter any cases of acute respiratory failure requiring intubation.