Matsumoto M, Watanabe K, Tuji T, Ishii K, Takaishi H, Nakamura M, Chiba K, Toyama Y
Department of Advanced Therapy for Spine and Spinal Cord, School of Medicine, Keio University, Tokyo, Japan.
Minim Invasive Neurosurg. 2007 Dec;50(6):335-9. doi: 10.1055/s-2007-993202.
The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation with a bony fragment due to apophyseal separation. Eighteen patients with low back pain and unilateral sciatic pain due to lumbar disc herniation with a bony fragment were treated by MED using the unilateral approach (15 males and three females; mean age, of 28.9 years; mean follow-up period, 21.1 months); 18 age-and sex-matched patients with lumbar disc herniation without a bony fragment treated by MED served as the control group. The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA scores; maximum score, 29 points). Evaluation of the results revealed that good surgical outcomes equivalent to those in the control group were obtained in the subjects of LDH with a bony fragment (JOA scores; 14.1+/-3.5 in the patient group vs.15.4+/-2.6 in the control group before surgery; 26.3+/-1.8 in the patient group vs. 26.9+/-1.3 at follow-up after the surgery). Although the mean surgical time was significantly longer in the patient group, there were no intra- or postoperative complications in either group. We conclude that MED using the unilateral approach is a feasible minimally invasive surgical option for patients of lumbar disc herniation with an apophyseal bony fragment.
本研究的目的是阐明显微内镜下椎间盘切除术（MED）治疗因椎体分离导致的伴有骨碎片的腰椎间盘突出症的可行性。18例因伴有骨碎片的腰椎间盘突出症而出现腰痛和单侧坐骨神经痛的患者采用单侧入路MED进行治疗（男性15例，女性3例；平均年龄28.9岁；平均随访期21.1个月）；18例年龄和性别匹配的无骨碎片的腰椎间盘突出症患者采用MED治疗作为对照组。使用日本骨科协会腰痛评分（JOA评分；最高分29分）评估临床结果。结果评估显示，伴有骨碎片的腰椎间盘突出症患者获得了与对照组相当的良好手术效果（JOA评分：患者组术前为14.1±3.5，对照组为15.4±2.6；患者组术后随访时为26.3±1.8，对照组为26.9±1.3）。虽然患者组的平均手术时间明显更长，但两组均未出现术中或术后并发症。我们得出结论，对于伴有椎体骨碎片的腰椎间盘突出症患者，采用单侧入路的MED是一种可行的微创手术选择。
