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经皮腰椎激光椎间盘切除术:文献综述及65例病例回顾性分析

Percutaneous Lumbar Laser Discectomy: Literature Review and a Retrospective Analysis of 65 Cases.

作者信息

Patel Nitesh, Singh Vikram

机构信息

Anesthesiology and Pain Management, California Back and Pain Specialist , Van Nuys, California.

出版信息

Photomed Laser Surg. 2018 Oct;36(10):518-521. doi: 10.1089/pho.2018.4460. Epub 2018 Sep 18.

DOI:10.1089/pho.2018.4460
PMID:30227091
Abstract

BACKGROUND

Percutaneous lumbar laser discectomy is a minimally invasive treatment option for patients with a contained disc herniation with back and/or leg pain.

OBJECTIVE

The goal of this study was to present our experience and results with patients who underwent percutaneous lumbar laser discectomy in our practice.

METHODS

A total of 65 patients were included, and their charts were retrospectively reviewed.

RESULTS

The most common level at which we performed the laser discectomy was the L5/S1 level 47.4% of the time. The next most common level was L4/L5 37.2% of the time and the least common level was L3/4 15.4% of the time. Neuritis was reported in four patients, which was treated with medication in two patients, and resolved in all four patients. The average preprocedure visual analog scale (VAS) score was 7.6/10 (range, 5-10/10). There was an improvement in the VAS score at 2-week follow-up. The average VAS score at 2-week follow-up was 3.7/10 (range, 0-10/10). The average VAS score at 6-week follow-up was 4.3/10 (range, 0-8/10). The average VAS score at 3-6 months was 4.1/10 [range, 0-8/10 and at 6-12 months was 4.2 (range, 0-8/10)].

CONCLUSIONS

Appropriate patient selection and following a systematic stepwise approach are important in treatment planning for patients in whom percutaneous laser discectomy is being considered. Following appropriate patient selection criteria maximizes the success rate of percutaneous laser discectomy. In our experience with patients with persistent back and/or leg pain not responding appropriately to conservative therapy, percutaneous laser discectomy offers a minimally invasive treatment option with nominal complications.

摘要

背景

经皮腰椎激光椎间盘切除术是治疗局限性椎间盘突出伴腰背痛和/或腿痛患者的一种微创治疗选择。

目的

本研究的目的是介绍我们在临床实践中对接受经皮腰椎激光椎间盘切除术患者的经验和结果。

方法

共纳入65例患者,并对其病历进行回顾性分析。

结果

我们进行激光椎间盘切除术最常见的节段是L5/S1节段,占47.4%。其次最常见的节段是L4/L5节段,占37.2%,最不常见的节段是L3/4节段,占15.4%。4例患者报告有神经炎,其中2例患者接受药物治疗,所有4例患者均康复。术前视觉模拟评分(VAS)平均得分为7.6/10(范围为5 - 10/10)。在2周随访时VAS评分有所改善。2周随访时VAS平均得分为3.7/10(范围为0 - 10/10)。6周随访时VAS平均得分为4.3/10(范围为0 - 8/10)。3 - 6个月时VAS平均得分为4.1/10[范围为0 - 8/10],6 - 12个月时为4.2(范围为0 - 8/10)。

结论

在考虑经皮激光椎间盘切除术的患者治疗计划中,合适的患者选择和遵循系统的逐步方法很重要。遵循合适的患者选择标准可使经皮激光椎间盘切除术的成功率最大化。根据我们对持续腰背痛和/或腿痛且对保守治疗反应不佳患者的经验,经皮激光椎间盘切除术提供了一种并发症极少的微创治疗选择。

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