Choi Kyung-Chul, Lee Dong Chan, Shim Hyeong-Ki, Shin Seung-Ho, Park Choon-Keun
Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, Republic of Korea.
Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Suwon, Republic of Korea.
World Neurosurg. 2017 Mar;99:259-266. doi: 10.1016/j.wneu.2016.12.052. Epub 2016 Dec 23.
Percutaneous endoscopic lumbar discectomy (PELD) with remarkable advancements has led to successful results comparable with open discectomy; however, its application in herniated disc (HD) with migration is still challenging and technically demanding. The purpose of this study is to propose various strategies for PELD according to HD with migration.
A retrospective review was performed on 434 consecutive patients who had undergone PELD. HD with migration was classified into 4 zones: low-grade up/down and high-grade up/down based on the extent and direction of migration. Clinical outcomes were assessed by visual analogue scale score for back and leg pain, Oswestry Disability Index, and modified Macnab criteria. Endoscopic approaches and techniques were analyzed depending on HD with migration.
A total of 149 patients underwent PELD for HD with migration. There were 93 low-grade down HD patients, 13 high-grade down, 11 low-grade up, and 32 high-grade up. High-grade up HDs were removed with the outside or outside-in techniques from L1-2 to L4-5. High-grade down HDs were removed via the outside technique with additional foraminoplasty. Low-grade up/down HDs with disc space continuity were removed with the inside-out technique. Meanwhile, at the L5-S1 level, interlaminar PELD was used to treat high-grade up/down HD with migration. The mean visual analogue scale score for back pain, leg pain, and Oswestry Disability Index were significantly improved after PELD. Favorable outcome was achieved in 90.6% of cases.
An appropriate strategy for PELD is important for successful removal of HD considering the extent of migration and direction.
经皮内镜下腰椎间盘切除术（PELD）取得了显著进展，其治疗效果与开放椎间盘切除术相当；然而，将其应用于伴有移位的椎间盘突出症（HD）仍具有挑战性且技术要求较高。本研究的目的是根据伴有移位的HD提出PELD的各种策略。
对434例连续接受PELD治疗的患者进行回顾性分析。根据移位的程度和方向，将伴有移位的HD分为4个区域：低度上下移位和高度上下移位。通过视觉模拟量表评估腰腿痛、Oswestry功能障碍指数和改良Macnab标准来评估临床疗效。根据伴有移位的HD分析内镜入路和技术。
共有149例患者因伴有移位的HD接受了PELD治疗。其中低度向下移位HD患者93例，高度向下移位13例，低度向上移位11例，高度向上移位32例。高度向上移位的HD采用外侧或由外向内技术从L1-2至L4-5进行切除。高度向下移位的HD通过外侧技术并附加椎间孔成形术进行切除。伴有椎间盘间隙连续性的低度上下移位HD采用由内向外技术切除。同时，在L5-S1水平，采用椎板间PELD治疗伴有移位的高度上下移位HD。PELD术后，背痛、腿痛的平均视觉模拟量表评分和Oswestry功能障碍指数均有显著改善。90.6%的病例获得了良好的治疗效果。
考虑到移位的程度和方向，选择合适的PELD策略对于成功切除HD至关重要。
