Lee Sang-Ho, Kang Han Sug
Department of Neurosurgery, Seoul Wooridul Hospital, Seoul 157-822, Korea.
World Neurosurg. 2010 Mar;73(3):198-206; discussion e33. doi: 10.1016/j.surneu.2009.01.023. Epub 2009 Mar 27.
Laser-assisted spinal endoscopy (LASE) kit has been used for percutaneous intradiscal decompression to evaporate and shrink the posterior and central nucleus for improvement of leg and radicular pain due to contained disc herniation. Percutaneous endoscopic laser annuloplasty (PELA), a new minimally invasive technique, uses LASE to directly coagulate the inflamed disc granulation tissue associated with annular tears. The small diameter of the endoscope including Ho:YAG laser, irrigation, and light, plus the extreme posterolateral approach into the posterior annulus, enables one to minimize damage to normal nuclear tissue. The authors sought to demonstrate the safety and efficacy of PELA for controlling discogenic low back pain (DLBP) due to abnormal disc tissues, new vessels, and nerves in the central torn posterior annulus.
Clinical outcomes of PELA were investigated in patients having DLBP with an annulus-torn degenerative disc or contained disc herniation. Thirty patients treated at a single level and achieving a mean follow-up of 9.7 months were analyzed. Outcomes were assessed using the visual analog scale (VAS) for back pain, the Korean Oswestry Disability Index (KODI), and the modified Macnab's criteria.
The mean back pain VAS score improved from 8.0 to 2.4, and the mean KODI score improved from 79.0 to 22.4 (P < .001). Results by the modified Macnab's criteria also showed a good outcome, with a success rate of 90.0%. There were no serious complications observed during follow-up.
Percutaneous endoscopic laser annuloplasty using the Ho:YAG laser provides favorable outcomes for carefully selected groups of patients with DLBP.
激光辅助脊柱内镜（LASE）套件已用于经皮椎间盘减压，以蒸发和收缩后核及中央核，从而改善因包容性椎间盘突出症引起的腿部和神经根性疼痛。经皮内镜激光纤维环成形术（PELA）是一种新的微创技术，它使用LASE直接凝固与纤维环撕裂相关的炎症性椎间盘肉芽组织。包括钬激光、冲洗和照明的内镜直径较小，加上经后外侧极入路进入后纤维环，能够将对正常核组织的损伤降至最低。作者试图证明PELA对于控制因中央撕裂后纤维环中的异常椎间盘组织、新生血管和神经引起的椎间盘源性下腰痛（DLBP）的安全性和有效性。
对患有纤维环撕裂性退变椎间盘或包容性椎间盘突出症的DLBP患者的PELA临床结果进行了研究。分析了30例在单一节段接受治疗且平均随访9.7个月的患者。使用视觉模拟量表（VAS）评估背痛、韩国奥斯威斯功能障碍指数（KODI）和改良Macnab标准来评估结果。
背痛VAS平均评分从8.
