Cho J Y, Lee S-H, Lee H-Y
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
Minim Invasive Neurosurg. 2011 Oct;54(5-6):214-8. doi: 10.1055/s-0031-1287774. Epub 2012 Jan 27.
Transforaminal percutaneous endoscopic lumbar discectomy (PELD) has become a routine surgical procedure because it is minimally invasive. Perioperative complications such as dural injury, infection, nerve root irritation and recurrence can occur not only with PELD, but also with conventional open microsurgery. In contrast, post-operative dysesthesia (POD) due to existing dorsal root ganglion (DRG) injury is a unique complication of PELD. When POD occurs, even if the traversing root has been successfully decompressed, it hinders swift recovery and delays the return to daily routines. Thus, prevention of POD is the key to successful and widespread use of PELD.
From January 2006 to December 2008, 154 patients underwent percutaneous endoscopic discectomy by floating retraction technique at 160 disc levels under local anesthesia. This approach towards the superomedial border of the lower pedicle and the cannula can be placed by gentle retraction of the root with perineural fat instead of direct compression of dorsal root ganglion. The clinical outcomes were assessed using the Visual Analogue Scale (VAS, 0-10 point) for radicular pain and low back pain, and using the Oswestry Disability Index (ODI) for functional status. Perioperative complications and recurrence were reviewed.
The mean age was 45 years, the mean operative time was 36 min and the mean follow-up period was 3.4 years. The mean hospital stay for endoscopic discectomy was 1.8 days. No patient underwent repeated PELD or convert microsurgery by incomplete removal of the ruptured particle. All patients experienced early relief of symptoms, as determined by VAS and ODI. No patient developed POD. 1 patient experienced dural injury. There was 1 case of discitis. The recurrence rate was 1.95% (3 patients).
Transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation is a safe and effective procedure. The floating retraction technique is recommended to avoid development of POD.
经椎间孔腰椎间盘切除术（PELD）因其微创性已成为一种常规手术。不仅PELD，传统的开放性显微手术也可能发生诸如硬脊膜损伤、感染、神经根刺激和复发等围手术期并发症。相比之下，由于存在背根神经节（DRG）损伤导致的术后感觉异常（POD）是PELD特有的并发症。当发生POD时，即使横过的神经根已成功减压，也会阻碍快速恢复并延迟恢复日常活动。因此，预防POD是PELD成功广泛应用的关键。
2006年1月至2008年12月，154例患者在局部麻醉下通过浮动牵开技术在160个椎间盘节段接受经皮内镜下椎间盘切除术。该方法朝向椎弓根下部的上内侧边界，通过用神经周围脂肪轻柔牵开神经根而非直接压迫背根神经节来放置套管。使用视觉模拟量表（VAS，0 - 10分）评估神经根性疼痛和腰痛的临床结果，并使用Oswestry功能障碍指数（ODI）评估功能状态。回顾围手术期并发症和复发情况。
平均年龄为45岁，平均手术时间为36分钟，平均随访期为3.4年。内镜下椎间盘切除术的平均住院时间为1.8天。没有患者因破裂颗粒清除不完全而接受重复PELD或转为显微手术。根据VAS和ODI确定，所有患者症状均早期缓解。没有患者发生POD。1例患者发生硬脊膜损伤。有1例椎间盘炎。复发率为1.95%（3例患者）。
经椎间孔腰椎间盘切除术治疗椎管内腰椎间盘突出症是一种安全有效的手术。建议采用浮动牵开技术以避免发生POD。
