Singh Suyash, Sardhara Jayesh C, Khatri Deepak, Joseph Jeena, Parab Abhijit N, Bhaisora Kamlesh S, Das Kuntal Kanti, Mehrotra Anant, Srivastava Arun Kumar, Behari Sanjay
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Craniovertebr Junction Spine. 2018 Apr-Jun;9(2):122-129. doi: 10.4103/jcvjs.JCVJS_47_18.
There is growing indications of minimally invasive spine surgery. The inherent attitude and institutive learning curve limit transition from standard open surgery to minimally invasive surgery demanding understanding of new instruments and correlative anatomy.
In this prospective study, 80 patients operated for lumbar disc prolapse were included in the study (between January 2016 and March 2018). Fifty patients (Group A) operated by various minimally invasive spine surgery (MISS) techniques for herniated disc disease were compared with randomly selected 30 patients (Group B) operated between the same time interval by standard open approach. Surgical outcome with Oswestry Disability Index (ODI) and patient satisfaction score was calculated in pre- and postoperative periods.
Mean preoperative ODI score in Group A was 31.52 ± 7.5 standard deviation (SD) (range: 6"46; interquartile range [IQR]: 8; median: 32.11) and postoperative ODI score was 9.20 ± 87.8 SD (range: 0"38; IQR: 11; median: 6.67). Mean preoperative ODI score in Group B was 26.47 ± 4.9 SD (range: 18"38; IQR: 4; median: 25) and postoperative ODI score was 12.27 ± 8.4 SD (range: 3"34; IQR: 12; median: 10.0). None of the patients was unsatisfied in either group. On comparing the patient satisfaction score among two groups, no significant difference ( = 0.27) was found.
On comparing the change in ODI and preoperative ODI among both groups, we found a significant difference between the groups. It is worth shifting from open to MISS accepting small learning curve. The satisfaction score of MISS in early transition period is similar to open procedure.
The MISS is safe and effective procedure even in transition period for the central and paracentral prolapsed lumbar intervertebral disc treatment. The results are comparable, and patient satisfaction and symptomatic relief are not compromised.
微创脊柱手术的应用越来越广泛。固有的态度和机构学习曲线限制了从标准开放手术向微创手术的转变，这需要了解新器械和相关解剖结构。
在这项前瞻性研究中，纳入了80例因腰椎间盘突出症接受手术的患者（2016年1月至2018年3月）。将50例采用各种微创脊柱手术（MISS）技术治疗椎间盘疾病的患者（A组）与在同一时间间隔内采用标准开放手术的30例随机选择的患者（B组）进行比较。在术前和术后计算采用Oswestry功能障碍指数（ODI）和患者满意度评分的手术结果。
A组术前ODI平均评分为31.52±7.5标准差（SD）（范围：6 - 46；四分位间距[IQR]：8；中位数：32.11），术后ODI评分为9.20±8.78 SD（范围：0 - 38；IQR：11；中位数：6.67）。B组术前ODI平均评分为26.47±4.9 SD（范围：18 - 38；IQR：4；中位数：25），术后ODI评分为12.27±8.4 SD（范围：3 - 34；IQR：12；中位数：10.0）。两组均无患者不满意。比较两组患者满意度评分，未发现显著差异（P = 0.27）。
比较两组ODI的变化和术前ODI，我们发现两组之间存在显著差异。接受较小的学习曲线，从开放手术转向MISS是值得的。MISS在早期过渡期的满意度评分与开放手术相似。
即使在过渡期，MISS对于中央型和旁中央型腰椎间盘突出症的治疗也是安全有效的手术。结果具有可比性，患者满意度和症状缓解不受影响。
