Choi Kyung-Chul, Lee June-Ho, Kim Jin-Sung, Sabal Luigi Andrew, Lee Sol, Kim Ho, Lee Sang-Ho
*Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, Korea; ‡Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea; §Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University, Seoul, Korea; ¶Department of Orthopeadics, Wooridul Spine Hospital, Seoul, Korea; ‖Department of Clinical Research, Wooridul Spine Hospital, Seoul, Korea.
Neurosurgery. 2015 Apr;76(4):372-80; discussion 380-1; quiz 381. doi: 10.1227/NEU.0000000000000628.
Percutaneous endoscopic lumbar discectomy (PELD) has remarkably evolved with successful results. Although PELD has gained popularity for the treatment of herniated disc (HD), the risk of surgical failure may be a major obstacle to performing PELD. We analyzed unsuccessful cases requiring reoperation.
To find common causes of surgical failure and elucidate the limitations of the conventional PELD technique.
A retrospective review was performed on all patients who had undergone PELD between January 2001 and December 2012. Unsuccessful PELD was defined as a case requiring reoperation within 6 weeks after primary surgery. Chart review was done, and preoperative, intraoperative, and postoperative radiographic reviews were performed. All unsuccessful PELD cases were classified according to the type of HD, location of herniation, extruded disc migration, working channel position, and intraoperative and postoperative findings.
In 12 years, 10,228 patients had undergone PELD; 436 (4.3%) cases were unsuccessful. The causes were incomplete removal of HDs in 283 patients (2.8%), recurrence in 78 (0.8%), persistent pain even after complete HD removal in 41 (0.4%), and approach-related pain in 21 (0.2%). Incomplete removal of the HD was caused by inappropriate positioning (95 cases; 33.6%) of the working channel and occurred in central HDs (91 cases; 32.2%), migrated HDs (70 cases; 24.7%), and axillary type HDs (63 cases; 22.3%).
Proper surgical indications and good working channel position are important for successful PELD. PELD techniques should be specifically designed to remove the disc fragments in various types of HD.
经皮内镜下腰椎间盘切除术（PELD）已经取得了显著进展，疗效良好。尽管PELD在治疗椎间盘突出症（HD）方面越来越受欢迎，但手术失败的风险可能是开展PELD的一个主要障碍。我们分析了需要再次手术的失败病例。
找出手术失败的常见原因，并阐明传统PELD技术的局限性。
对2001年1月至2012年12月期间所有接受PELD手术的患者进行回顾性研究。PELD手术失败定义为初次手术后6周内需要再次手术的病例。查阅病历，并进行术前、术中和术后影像学检查。所有PELD手术失败病例根据HD类型、突出位置、脱出椎间盘移位情况、工作通道位置以及术中和术后发现进行分类。
在12年中，10228例患者接受了PELD手术；436例（4.3%）手术失败。原因包括283例患者（2.8%）HD切除不完全，78例（0.8%）复发，41例（0.4%）即使HD完全切除后仍持续疼痛，21例（0.2%）与手术入路相关的疼痛。HD切除不完全是由于工作通道定位不当（95例；33.6%），发生在中央型HD（91例；32.2%）、移位型HD（70例；24.7%）和腋下型HD（63例；22.3%）。
合适的手术适应症和良好工作通道位置对PELD手术成功很重要。PELD技术应专门设计用于清除各种类型HD中的椎间盘碎片。
