Wong Kin Weng, Ho Chung-Han, Yu Tzai-Chiu, Wu Chung-Da, Tsang Yi-Sheng
Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
World Neurosurg. 2018 Oct;118:e367-e374. doi: 10.1016/j.wneu.2018.06.192. Epub 2018 Jun 30.
Foraminal disc herniation is rare. When conservative treatment fails, it is often treated with discectomy via a paraspinal or Wiltse approach. In contained foraminal disc herniation, more symptoms arise from the foraminal compression of the exiting nerve root, including the dorsal root ganglion, than from the herniation itself. We aimed to evaluate the benefits of stand-alone decompression without discectomy for patients with contained foraminal disc herniation.
This study included 17 patients with unilateral single-level foraminal disc herniation (14 women and 3 men; mean age, 62.8 ± 14.6 years, range, 37-86 years). Disc herniation was confirmed as contained by preoperative magnetic resonance imaging and/or computed tomography and by intraoperative exploration. All patients underwent thorough decompression without discectomy, via a paraspinal approach. Pain was evaluated preoperatively and at 3 and 12 months postoperatively using a visual analog scale (VAS). The Oswestry Disability Index (ODI) and Macnab criteria were used to evaluate final outcomes.
The most commonly affected level was L5-S1. All 17 patients showed significant improvements in VAS and ODI scores at 3 and 12 months postoperatively. According to the Macnab criteria, outcome results were excellent in 13 patients and good in 4. The mean duration of follow-up was 18.4 ± 2.4 months, with no recurrences or lumbar instability at the final follow-up.
Stand-alone decompression without discectomy is an effective method for relieving symptoms and preserving the disc in contained foraminal disc herniation. A minimally invasive approach with thorough decompression techniques yields good results.
椎间孔型椎间盘突出症较为罕见。当保守治疗失败时，通常采用经椎旁或威尔茨（Wiltse）入路行椎间盘切除术进行治疗。在包容性椎间孔型椎间盘突出症中，相较于突出本身，更多症状是由包括背根神经节在内的穿出神经根在椎间孔处受压引起的。我们旨在评估对于包容性椎间孔型椎间盘突出症患者，不进行椎间盘切除术而单纯减压的益处。
本研究纳入了17例单侧单节段椎间孔型椎间盘突出症患者（14例女性和3例男性；平均年龄62.8±14.6岁，范围37 - 86岁）。术前磁共振成像和/或计算机断层扫描以及术中探查均证实椎间盘突出为包容性。所有患者均通过椎旁入路进行了不切除椎间盘的彻底减压。术前以及术后3个月和12个月使用视觉模拟量表（VAS）评估疼痛情况。采用奥斯维斯特里功能障碍指数（ODI）和麦克纳布（Macnab）标准评估最终结局。
最常受累节段为L5 - S1。所有17例患者术后3个月和12个月时VAS和ODI评分均有显著改善。根据麦克纳布标准，13例患者结局为优，4例为良。平均随访时间为18.4±2.4个月，末次随访时无复发或腰椎不稳情况。
对于包容性椎间孔型椎间盘突出症患者，不进行椎间盘切除术而单纯减压是缓解症状并保留椎间盘的有效方法。采用微创入路并结合彻底减压技术可取得良好效果。
