Hong Xin, Shi Rui, Wang Yun-Tao, Liu Lei, Bao Jun-Ping, Wu Xiao-Tao
Spine Surgery Center, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao, 210009, Nanjing, Jiangsu, China.
Orthopade. 2018 Dec;47(12):993-1002. doi: 10.1007/s00132-018-3624-6.
Microendoscopic discectomy (MED) is becoming an established and effective minimally invasive surgical method for the treatment of lumbar disc herniation (LDH); however, the absence of prognostic factors for long-term outcomes after MED results in a lack of specific criteria for appropriate patient selection. Therefore, we evaluated the long-term outcomes and associated predictors in patients who underwent MED for LDH.
Baseline and follow-up data for 664 LDH patients who suffered from sciatica and underwent primary MED were reviewed retrospectively. Variables at baseline that were analyzed as potential prognostic factors included sociodemographic characteristics, clinical findings, and imaging features. Follow-up data including improvements in the Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), postoperative low back pain (LBP), reoperation, and excellent/good results according to the modified MacNab criteria were set as outcome variables for univariate and further multivariate logistic regression analyses.
The mean follow-up period was 63.8 ± 20.0 months (range 24-96 months). On average, sufficient improvements in both the VAS score (72.8%) and ODI (63.4%) were observed. In addition, a low postoperative LBP rate (23.9%), low reoperation rate (7.1%), and high rate of excellent/good clinical outcomes (89.9%) were achieved. A multivariate analysis indicated that older age, shorter disease duration, higher preoperative VAS score, lower preoperative ODI, shorter surgical time, lower severity of disc and adjacent disc degeneration, and lower severity of lumbar multifidus atrophy contributed to superior clinical outcomes.
Excellent long-term outcomes after primary MED were achieved and specific sociodemographic, clinical, and imaging variables were identified as prognostic factors that can be used to guide patient selection and clinical decision making.
显微内镜下椎间盘切除术（MED）正成为一种成熟且有效的治疗腰椎间盘突出症（LDH）的微创手术方法；然而，MED术后长期疗效的预后因素缺失导致缺乏合适患者选择的具体标准。因此，我们评估了接受MED治疗LDH患者的长期疗效及相关预测因素。
回顾性分析664例因坐骨神经痛接受初次MED治疗的LDH患者的基线和随访数据。作为潜在预后因素进行分析的基线变量包括社会人口学特征、临床表现和影像学特征。随访数据包括视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）的改善情况、术后下腰痛（LBP）、再次手术情况以及根据改良MacNab标准得出的优良结果，将这些作为单因素和进一步多因素逻辑回归分析的结局变量。
平均随访期为63.8±20.0个月（范围24 - 96个月）。平均而言，VAS评分（72.8%）和ODI（63.4%）均有充分改善。此外，术后LBP发生率低（23.9%）、再次手术率低（7.1%）且临床优良率高（89.9%）。多因素分析表明，年龄较大、病程较短、术前VAS评分较高、术前ODI较低、手术时间较短、椎间盘及相邻椎间盘退变程度较低以及腰大肌萎缩程度较低有助于获得更好的临床疗效。
初次MED术后取得了优异的长期疗效，并确定了特定的社会人口学、临床和影像学变量作为预后因素，可用于指导患者选择和临床决策。
