Bai Yi-bing, Xu Ling, Xi Jian-cheng, Mu Xiao-jing
Department of Orthopedics, PLA No. 309 Hospital, Beijing 100091, China.
Zhonghua Yi Xue Za Zhi. 2012 Dec 18;92(47):3350-3.
To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery.
From December 2009 to June 2010, 119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia. There were 75 males and 44 females with a mean age of 44.8 years (range: 15 - 55). The mean disease course was 9 months (range: 3 - 72). The major symptoms were back pain and/or unilateral sciatica. The mean follow-up period was 26 months. All underwent lumbar radiography, computed tomography (CT) and magnetic resonance imaging (MRI) revealing 112 single level and 7 two-level disc herniations. There were 82 lateral and 37 para-medial disc herniations. Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolisthesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Precise orientation and operation was performed under the guidance of pre-operative imaging, intra-operative fluoroscopy or CT and endoscopic exploration.
Among them, 117 cases had the surgery performed successfully. The mean operative duration was 85 min (range: 35 - 85) and the mean blood loss 13 ml (range: 1 - 50). One patient had L5 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months. Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter. Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically. No one had a conversion into open surgery. They were followed up for a mean period of 26.1 months (range: 25 - 27). Five patients lost follow-up. VAS improved statistically significantly from preoperative 6.8 to postoperative 1.8 (P < 0.05). ODI decreased from preoperative 70.06 to 19.09 at the last follow-up. The Macnab results were excellent (n = 82, 68.9%), good (n = 20, 16.7%), fair (n = 8, 6.7%) and bad (n = 9, 7.7%) (including all patients lost to follow-up). And the excellent-to-good rate was 85.6%.
With fewer complications and a low recurrence rate, percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.
对椎间盘造影和经皮椎间孔镜手术治疗腰椎间盘突出症进行回顾性分析。
2009年12月至2010年6月，119例腰椎间盘突出症患者在局部麻醉下接受了椎间盘造影和椎间孔镜手术。其中男性75例，女性44例，平均年龄44.8岁（范围：15 - 55岁）。平均病程9个月（范围：3 - 72个月）。主要症状为腰痛和/或单侧坐骨神经痛。平均随访期为26个月。所有患者均接受了腰椎X线摄影、计算机断层扫描（CT）和磁共振成像（MRI）检查，发现112个单节段和7个双节段椎间盘突出。其中82个为外侧型椎间盘突出，37个为旁中央型椎间盘突出。89例为椎间盘膨出，30例为椎间盘脱垂和游离。无明显腰椎管狭窄、椎体滑脱、骨折、感染或肿瘤病例。采用术前和术后视觉模拟评分（VAS）评估坐骨神经痛和/或腰痛情况。采用Oswestry功能障碍指数（ODI）和Macnab评分评估疗效。在术前影像学、术中透视或CT及内镜探查引导下进行精确的定位和操作。
其中117例手术成功。平均手术时间85分钟（范围：35 - 85分钟），平均出血量13毫升（范围：1 - 50毫升）。1例患者发生L5神经根损伤，伴有患侧下肢感觉异常和无力，经3个多月保守治疗后逐渐缓解。另1例术后并发椎间盘内感染，转至其他机构，此后失访。5例患者在首次手术后6个月无改善，接受了内镜再次手术。无人转为开放手术。平均随访26.1个月（范围：25 - 27个月）。5例患者失访。VAS评分从术前的6.8分显著改善至术后的1.8分（P < 0.05）。ODI在末次随访时从术前的70.06降至19.09。Macnab结果为优（n = 82，68.9%）、良（n = 20，16.7%）、可（n = 8，6.7%）和差（n = 9，7.7%）（包括所有失访患者）。优良率为85.6%。
经皮椎间孔镜手术治疗腰椎间盘突出症并发症少、复发率低，安全有效。
