经椎间孔内镜下腰椎间盘切除术治疗引起双侧症状的腰椎间盘突出症

Transforaminal Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Causing Bilateral Symptoms.

作者信息

Ren Chunpeng, Li Yin, Qin Rujie, Sun Penghao, Wang Peng

机构信息

Department of Orthopedics, Lianyungang No.1 People's Hospital, Xuzhou Academy of Medical Sciences, Lianyungang, China.

出版信息

World Neurosurg. 2017 Oct;106:413-421. doi: 10.1016/j.wneu.2017.06.191. Epub 2017 Jul 12.

DOI:10.1016/j.wneu.2017.06.191

PMID:28710050

Abstract

BACKGROUND

Transforaminal endoscopic lumbar discectomy (TELD), a minimally invasive spinal technique, has advantages over open discectomy. Unilateral TELD for disc herniation causing bilateral symptoms is challenging. In this study, we describe a percutaneous endoscopic herniotomy technique by using a unilateral approach for lumbar disc herniation with bilateral obvious symptoms.

METHODS

From June 2014 to October 2015, 26 patients who had back as well as bilateral leg pain and/or weakness due to lumbar disc herniation were treated by TELD with a unilateral approach. Clinical outcomes were evaluated via a visual analogue scale (VAS; 0-10), and functional status was assessed with the Oswestry Disability Index (0-100%) postoperatively and 3 and 12 months postoperatively. Surgical satisfaction rate was assessed during the final follow-up.

RESULTS

The mean VAS for leg pain on the operative side improved from preoperative 8.39 ± 1.84 to 2.18 ± 1.26 postoperatively, 1.96 ± 0.83 at 3 months postoperatively, and 2.05 ± 1.42 at 1 year postoperatively (P < 0.01). The mean VAS for leg pain on the contralateral was 7.12 ± 1.74 and improved to 1.57 ± 1.66 postoperatively, 1.22 ± 1.58 at 3 months postoperatively, and 1.15 ± 1.35 at 1 year postoperatively (P < 0.01). The mean preoperative Oswestry Disability was 83.63 ± 8.49, with 23.58 ± 7.24 at 1 week postoperatively, 19.81 ± 11.26 at 3 months postoperatively, and 17.54 ± 13.40 at 12 months postoperatively (P < 0.01). Good or excellent global results were obtained in 96.2% of patients.

CONCLUSIONS

TELD can be effective for lumbar disc herniation causing bilateral symptoms, through one working channel.

摘要

背景

经椎间孔内镜下腰椎间盘切除术（TELD）是一种微创脊柱技术，优于开放性椎间盘切除术。采用单侧TELD治疗引起双侧症状的椎间盘突出症具有挑战性。在本研究中，我们描述了一种经皮内镜下疝修补术技术，该技术采用单侧入路治疗具有双侧明显症状的腰椎间盘突出症。

方法

2014年6月至2015年10月，对26例因腰椎间盘突出症导致腰背部及双侧腿痛和/或无力的患者采用单侧入路TELD进行治疗。通过视觉模拟量表（VAS；0 - 10）评估临床结果，并在术后、术后3个月和12个月时用Oswestry功能障碍指数（0 - 100%）评估功能状态。在最后一次随访时评估手术满意率。

结果

患侧腿部疼痛的平均VAS评分从术前的8.39±1.84改善至术后的2.18±1.26，术后3个月为1.96±0.83，术后1年为2.05±1.42（P < 0.01）。对侧腿部疼痛的平均VAS评分术前为7.12±1.74，术后改善至1.57±1.66，术后3个月为1.22±1.58，术后1年为1.15±1.35（P < 0.01）。术前Oswestry功能障碍指数平均为83.63±8.49，术后1周为23.58±7.24，术后3个月为19.81±11.26，术后12个月为17.54±13.40（P < 0.01）。96.2%的患者获得了良好或优秀的总体结果。