L4-L5节段经皮椎间孔镜下腰椎间盘切除术的初步临床疗效

Initial Clinical Outcomes of Percutaneous Full-Endoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5.

作者信息

Nakamura Jun-Ichiro, Yoshihara Kiyoshi

机构信息

Kawasaki Saiwai Hospital Kawasaki, Kanagawa Prefecture, Japan.

出版信息

Pain Physician. 2017 May;20(4):E507-E512.

PMID:28535559

Abstract

BACKGROUND

Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported.

OBJECTIVE

This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF.

STUDY DESIGN

Retrospective evaluation.

SETTING

An urban minimally invasive spine hospital.

METHODS

Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1.

RESULTS

The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.).

LIMITATIONS

A small sample size and a short follow-up period.

CONCLUSIONS

The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation.

摘要

背景

经皮全内镜下椎间盘切除术（PED）因其能最大程度减少软组织损伤并缩短住院时间而被越来越多地应用。只有少数外科医生开展L4 - L5节段经椎板间入路的PED（PED - IL）。据我们所知，此前尚无关于未开展过经椎间孔入路PED（PED - TF）经验的医生进行L4 - L5节段PED - IL安全性和有效性的报道。

目的

本研究旨在评估未开展过PED - TF经验的医生进行L4 - L5节段PED - IL的初始临床疗效及并发症。

研究设计

回顾性评估。

研究地点

一家城市微创脊柱医院。

方法

总共50例患者（36例男性和14例女性，年龄21 - 59岁，平均年龄40.3岁），其中16例在L4 - L5节段进行手术，34例在L5 - S1节段进行手术。所有病例均成功完成PED - IL，无一例需要转为开放手术。对L5 - S1节段（范围：41 - 112分钟）的手术时间、住院时间、改良MacNab标准及视觉模拟量表（VAS）评分进行了检查。L4 - L5组和L5 - S1组手术时间无显著差异；手术时间逐渐缩短。平均住院时间为2.9天（范围：2 - 8天）。根据改良MacNab标准，20例（L4 - L5节段6例，L5 - S1节段14例）为优，27例（L4 - L5节段10例，L5 - S1节段17例）为良，L5 - S1节段1例为可，L5 - S1节段2例为差。L5 - S1节段发生2例神经束膜撕裂。无感染或椎间盘突出复发。L4 - L5节段PED - IL的临床疗效与L5 - S1节段相当。