title: Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation.
abstract: BACKGROUND
  Many patients suffer from radiculopathy and low back pain due to lumbar disc hernia. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive method that accesses the disc pathology through the intervertebral foramen. Health-related quality of life (HRQoL) has been previously assessed for this method. However, a possible effect of the level of operation on the postoperative progress of HRQoL remains undefined.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the impact of the level of operation on HRQoL, following TPED.
  
  
  METHODS
  A total of 76 patients diagnosed with lumbar disc hernia were enrolled in the study. According to the level of operation, they were divided into three groups: Group A (21 patients) for L3-L4, Group B (40 patients) for L4-L5, and Group C (15 patients) for L5-S1 intervertebral level. All patients underwent TPED. Their HRQoL was evaluated by the short-form-36 (SF-36) health survey questionnaire before the operation and at 6 weeks, 3, 6, and 12 months postsurgery. The progress of SF-36 was analyzed in relation to the operated level.
  
  
  RESULTS
  All aspects of SF-36 showed statistical significant improvement, at every given time interval (P≤ 0.05) in the total of patients and in each group separately. Group A had a significantly higher increase in physical functioning (PF) score at 3 and 12 months postsurgery (P= 0.046 andP= 0.056, respectively). On the other hand, Group B had a significant lower increase in mental health (MH) score at 6 months (P= 0.009) postoperatively.
  
  
  CONCLUSIONS
  Our study concludes that the level of operation in patients who undergo TPED for lumbar disc herniation affects the HRQoL 1 year after surgery, with Group A having a significantly greater improvement of PF in comparison with Groups B and C.
authors.affiliation: Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Kapetanakis
authors.affiliation: Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Charitoudis
authors.affiliation: Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Tryfon
authors.initials: T
authors.lastname: Thomaidis
authors.affiliation: Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Theodosiadis
authors.affiliation: Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Plovdiv Medical University, Plovdiv, Bulgaria; Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria.
authors.forename: Jannis
authors.initials: J
authors.lastname: Papathanasiou
authors.affiliation: Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Giatroudakis
keywords: Health-related quality of life; low back pain; lumbar disc herniation; short-form-36 health survey; transforaminal percutaneous endoscopic discectomy