Sahlstrand T, Lönntoft M
Department of Orthopaedics, Helsingborg Hospital, Sweden.
J Spinal Disord. 1999 Oct;12(5):368-74.
The authors evaluated the size of the disc herniation with magnetic resonance imaging (MRI) before and after surgery in patients undergoing automated percutaneous lumbar discectomy (APLD) and compared the MRI findings with the early clinical outcome. This study includes 20 consecutive patients with a contained lumbar disc herniation. Sequential MRI were performed immediately before and after surgery, on the day of surgery, and 6 weeks after surgery. The development of pain, nerve root tension sign (SLR), and neurological findings were analyzed, as was the need for subsequent open surgery. There was no significant difference in the maximum protrusion of the disc herniation between the three measurements. The sciatic pain improved significantly on the first day after surgery but not at 1 week or 6 weeks after surgery. The SLR was reduced significantly after surgery and at 1 and 6 weeks after surgery. There was no correlation between the MRI findings and the early clinical outcome. Seven patients needed subsequent open surgery. The findings indicate that the effect of APLD is not mediated by reducing the size of the disc herniation. In this small series of patients, APLD was ineffective in the treatment of a contained lumbar disc herniation. There was no correlation between the MRI findings and the early clinical outcome.
作者对接受自动经皮腰椎间盘切除术（APLD）的患者在手术前后进行磁共振成像（MRI）评估椎间盘突出的大小，并将MRI结果与早期临床结果进行比较。本研究纳入了20例连续的包容性腰椎间盘突出症患者。在手术前、手术当日、手术后6周立即进行连续的MRI检查。分析疼痛的发展、神经根张力征（直腿抬高试验，SLR）和神经学检查结果，以及后续进行开放手术的必要性。三次测量之间椎间盘突出的最大突出程度无显著差异。坐骨神经痛在术后第一天显著改善，但在术后1周和6周时未改善。术后以及术后1周和6周时SLR均显著降低。MRI结果与早期临床结果之间无相关性。7例患者需要后续的开放手术。研究结果表明，APLD的效果不是通过减小椎间盘突出的大小来介导的。在这一小系列患者中，APLD对包容性腰椎间盘突出症的治疗无效。MRI结果与早期临床结果之间无相关性。
