Clinical Study of Hydraulic Perfusion Pump and Traditional Water Jet Irrigation for Percutaneous Endoscopic Lumbar Discectomy

Objective: To compare clinical outcomes of hydraulic perfusion pump and traditional water jet irrigation in percutaneous endoscopic lumbar discectomy by a prospective randomized controlled study. Methods: From January 2016 to December 2018, 72 patients with lumbar disc herniation and failed conservative treatment were enrolled in this study. According to the odd number of the last digit of the hospitalization number, the patients were randomly divided into a hydraulic perfusion pump group and a traditional water jet irrigation group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative pain visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores between two groups (P>0.05). The same surgeon performed all operations. These operations were performed by hydraulic perfusion pump flushing and traditional water flushing assisted surgery. The patients were followed up for 12 to 24 months (mean 15.7 months). The operation time, blood loss, hospital time, visual analog scale (VAS) for follow-up pain after one day and two weeks, and the last follow-up JOA scores. The type and incidence of postoperative complications were compared between two groups.Results: Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was short [(65.5±21.3) min vs. (74.8±19.9) min, t=9.465, P=0.003]. Blood loss was less [(21.2±12.9) ml vs. (27.4±14.1) ml, t=8.331, P=0.012]; there was no statistical difference in hospitalization time. The pain visual analog scale (VAS) and the last follow-up JOA scores in one day, two weeks were better than preoperative, but there was no statistical difference between the groups (P>0.05). In the traditional water flushing group, the symptoms of increased intracranial pressure like headache and neck pain occurred during the operation, which was forced to shorten the operation time in 5 cases, nerve root adventitia injury in 4 cases, and postoperative recurrence in 4 cases. In the hydraulic perfusion pump group, no patient had the symptoms of increased intracranial pressure like headache and neck pain, and nerve root adventitia injury in 1 case and 2 cases of postoperative recurrence. The incidence of complications in the hydraulic perfusion group was lower than that in the traditional water flow group. Conclusion：Hydraulic perfusion pump and traditional water-flow irrigation assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results. However, the former has short operation time, clear vision in operation, less bleeding, and less in-operation and postoperative complications.