Konovalov N A, Asyutin D S, Korolishin V A, Cherkiev I U, Zakirov B A
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(5):56-62. doi: 10.17116/neiro201781556-62.
Modern surgery uses a variety of treatments for spine pathology. Endoscopic techniques have become particularly popular across the world over the past decade. In this article, we summarize our experience and analyze the immediate and long-term results of surgical treatment of lumbar disc herniation using a percutaneous fully endoscopic technique for removing the herniated intervertebral disc, which is new for Russian medical practice.
to evaluate the efficacy of percutaneous endoscopic discectomy in the treatment of herniated lumbar discs in patients with radicular pain syndrome.
We conducted a cohort retrospective study that included 69 patients who underwent herniated disc removal using the percutaneous endoscopic technique. Surgery was performed through two approaches: the intralaminar approach was used in 44 patients, and the transforaminal approach was used in 25 patients. To assess the efficacy of surgery, we used a visual analogue scale (VAS) of pain: the intensity of local pain (VAS1) and the intensity of radicular pain (VAS2). Changes in the quality of life and ability to work were assessed by using the Oswestry scale; patient satisfaction with treatment was assessed by using the MacNab scale.
The mean follow-up period after surgery was 24 months. An analysis of changes in the pain syndrome (VAS1 and VAS2) before surgery and in the early postoperative period demonstrated a significant regression of pain regardless of the approach type (r=0.25). Patients' survey (MacNab scale) in the long-term postoperative period revealed no unsatisfactory results; excellent, good, and satisfactory results were observed in 21 (30%), 32 (46%), and 16 (24%) patients, respectively.
Percutaneous endoscopic discectomy is an effective surgical treatment for degenerative diseases of the lumbosacral spine, providing excellent and good treatment outcomes in most operated patients.
现代外科手术针对脊柱病变采用多种治疗方法。在过去十年中，内镜技术在全球范围内变得尤其流行。在本文中，我们总结了我们的经验，并分析了使用经皮全内镜技术切除突出椎间盘治疗腰椎间盘突出症的手术近期和长期结果，这在俄罗斯医学实践中是新的。
评估经皮内镜下椎间盘切除术治疗伴有神经根性疼痛综合征患者腰椎间盘突出症的疗效。
我们进行了一项队列回顾性研究，纳入了69例行经皮内镜技术切除椎间盘的患者。手术通过两种入路进行：44例患者采用椎板间入路，25例患者采用椎间孔入路。为评估手术疗效，我们使用了疼痛视觉模拟量表（VAS）：局部疼痛强度（VAS1）和神经根性疼痛强度（VAS2）。使用Oswestry量表评估生活质量和工作能力的变化；使用MacNab量表评估患者对治疗的满意度。
术后平均随访期为24个月。对手术前和术后早期疼痛综合征（VAS1和VAS2）变化的分析表明，无论入路类型如何，疼痛均有显著缓解（r = 0.25）。术后长期患者调查（MacNab量表）显示无不满意结果；分别有21例（30%）、32例（46%）和16例（24%）患者获得优、良和满意结果。
经皮内镜下椎间盘切除术是治疗腰骶部脊柱退行性疾病的有效手术方法，在大多数手术患者中提供了优良的治疗效果。
