JAMA. 1991 Apr 24;265(16):2122-3, 2125.
Although the safety of the APLD procedure is clearly established both by reports in the published literature and by a consensus of the DATTA panelists, there was no consensus among the DATTA panelists on the effectiveness of the procedure. The average 75% success rate reported in the larger studies contrasts with the 95% success rate reported for laminectomy and diskectomy. For APLD, careful patient selection is essential. Candidates must have failed an adequate trial of conservative therapy (bed rest and limitation of activity) and have disk herniation documented by appropriate imaging studies. These studies are important because they can demonstrate not only the degree of herniation, but also whether it is contained within the annulus and if any free fragments are present. For herniated lumbar disks with nuclear material outside and contiguous with the annulus, a statistically significant consensus of DATTA panelists believed that APLD is an inappropriate procedure. Another study has shown that the procedure can be taught to other surgeons without compromising patient safety, and, as reported, this holds with large numbers of cases. In appropriately selected patients, the clinical trade-off of APLD appears to be between a procedure with a 75% success rate with low risk and rapid recovery vs one with a 95% success rate and a more prolonged recovery. A research question is whether APLD could be extended to patients who have undergone previous surgery whose disks reherniate after a successful laminectomy. Conversely, does an APLD procedure that fails to relieve symptoms complicate subsequent laminectomy? It is recognized that there is a need for prospective, controlled, randomized clinical trials comparing APLD with laminectomy to resolve these and other issues.
尽管经皮自动腰椎间盘摘除术（APLD）的安全性已在已发表文献的报告以及DATTA小组成员的共识中得到明确证实，但DATTA小组成员对于该手术的有效性并未达成共识。大型研究报告的平均成功率为75%，这与椎板切除术和椎间盘切除术报告的95%成功率形成对比。对于APLD而言，仔细选择患者至关重要。候选人必须经过充分的保守治疗（卧床休息和活动受限）试验失败，并且有经适当影像学检查记录的椎间盘突出。这些研究很重要，因为它们不仅可以显示突出的程度，还可以显示其是否包含在纤维环内以及是否存在游离碎片。对于髓核物质在纤维环外且与纤维环相邻的腰椎间盘突出症，DATTA小组成员在统计学上有显著共识，认为APLD是一种不适当的手术。另一项研究表明，该手术可以传授给其他外科医生而不影响患者安全，并且，如所报道的，大量病例均如此。在适当选择的患者中，APLD的临床权衡似乎在于成功率为75%、风险低且恢复快的手术与成功率为95%但恢复时间更长的手术之间。一个研究问题是APLD是否可以扩展到先前接受过手术且在成功的椎板切除术后椎间盘复发的患者。相反，未能缓解症状的APLD手术是否会使随后的椎板切除术复杂化？人们认识到，需要进行前瞻性、对照、随机临床试验，比较APLD与椎板切除术，以解决这些及其他问题。
