To examine the clinical results of different minimally invasive techniques for the therapy of far lateral disc herniation in middle-aged and elderly patients. An endoscopic approach (percutaneous endoscopic lumbar discectomy; PELD), MIS-TLIF combined with contralateral translaminar screw (MIS-TLIF CTS), and MIS-TLIF combined with bilateral pedicle screws (MIS-TLIF BPS) were evaluated via a retrospective chart review. Data from 74 consecutive middle-aged and elderly patients with far lateral disc herniation were analyzed. All patients underwent surgery; 19 with PELD, 24 with MIS-TLIF CTS, and 31 with MIS-TLIF BPS. Clinical data included the length of the incision, duration of the operation, estimated blood loss, hospitalization time, operation cost, recurrence rate, and fusion rate. Preoperative and postoperative patient outcomes including the VAS, ODI scores and MacNab criteria were assessed and recorded. The mean follow-up time was 26.4 months (range from 14 to 46 months). Compared with the internal fixation groups, the length of the incision, duration of operation, estimated blood loss, and hospitalization time were obviously lower in the PELD group. The difference in operation cost among the three methods was statistically significant. The postoperative VAS scores for LBP and LP decreased significantly as compared with those recorded preoperatively. The postoperative ODI scores were lower than those recorded preoperatively. MacNab criteria rating excellent, good and fair results were in 27, 37 and 10 patients, respectively. Conclusion: PELD, MIS-TLIF CTS, and MIS-TLIF BPS are all effective minimally invasive techniques for the therapy of single segment far lateral lumbar disc herniation in middle-aged and elderly patients. PELD had a shorter operation time and less surgical trauma, being a less invasive and more economical method; however, there was no recurrence of disc herniation after fixation. Compared with MIS-TLIF BPS, MIS-TLIF CTS obtained a similar clinical effect and certain costs were saved.

观察不同的微创技术治疗中老年人远侧椎间盘突出症的临床结果。通过回顾性图表审查，评估了内镜方法（经皮内镜腰椎间盘切除术； PELD），MIS-TLIF联合对侧经椎椎板螺钉（MIS-TLIF CTS）和MIS-TLIF联合双侧椎弓根螺钉（MIS-TLIF BPS）。分析了来自连续74例中远侧椎间盘突出症的中老年患者的数据。所有患者均接受手术治疗；PELD为19，MIS-TLIF CTS为24，MIS-TLIF BPS为31。临床数据包括切口长度，手术时间，估计失血量，住院时间，手术费用，复发率和融合率。术前和术后患者预后包括VAS，评估并记录ODI评分和MacNab标准。平均随访时间为26.4个月（14个月至46个月）。与内固定组相比，PELD组的切口长度，手术时间，估计失血量和住院时间均明显降低。三种方法之间的运营成本差异具有统计学意义。与术前记录相比，术后LBP和LP的VAS评分明显降低。术后ODI评分低于术前记录。MacNab标准分别对27例，37例和10例患者进行了评价，结果良好，良好和公平。结论：PELD，MIS-TLIF CTS，MIS-TLIF BPS和MIS-TLIF BPS都是有效的微创技术，可用于治疗中老年患者的单节远外侧腰椎间盘突出症。PELD手术时间短，手术创伤小，是一种创伤小，经济的方法。但是，固定后无椎间盘突出症复发。与MIS-TLIF BPS相比，MIS-TLIF CTS具有类似的临床效果，并节省了一定的成本。