Liu Chao, Zhou Yue
Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China.
Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No.183, Xinqiao Street, Shapingba District, Chongqing 400037, People's Republic of China.
Clin Neurol Neurosurg. 2019 Jan;176:19-24. doi: 10.1016/j.clineuro.2018.10.017. Epub 2018 Oct 29.
To compare the clinical outcomes of patients with massive lumbar disc disease undergoing percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion at a single clinic.
From January 2008 to January 2014, 360 consecutive patients with massive lumbar disc herniation were treated with PELD(184 patients) or MIS-TLIF(176 patients). Data collected prospectively for analysis included clinical and radiographic results after revision surgery and complications.
During the follow-up period, postoperative data between two treatment groups showed no significant difference in the mean total postoperative VAS score for leg pain, JOA and ODI scores. The recovery rate was 89.3% in the PELD and 93.4% in MIS-TLIF groups, respectively. Satisfaction rates were 86.3% in the PELD group and 92.2% in the MIS-TLIF group. Four cases of dural tear were observed in the MIS-TLIF group. Recurrence manifested in 14 patients in the PELD group, and one patient in this group also suffered permanent neurologic deficit. One case of postoperative intervertebral infection was recorded in the MIS-TLIF group.
A comparison of PELD and MIS-TLIF for treating massive lumbar disc herniation revealed that both showed favorable clinical outcomes but had different sets of complications. Compared to MIS-TLIF, PELD had the following advantages: (1) its feasibility under local anesthesia and (2) the rarity of "fusion disease," such as ASD. However, the PELD is also revealed several problems, including a relatively lower success rate and satisfaction,a relative higher rate of postoperative long-term chronic low back pain and the possibility of recurrence, despite low opportunity. Therefore, the main difference between these two treatments was related to postoperative complications and the satisfaction and recovery rates. We suggest that, in the future, multi-center studies, recruiting a larger number of patients, should be undertaken to better understand the clinical relevance of these complications.
在单一诊所比较接受经皮内镜下腰椎间盘切除术和微创经椎间孔腰椎椎间融合术治疗的巨大腰椎间盘疾病患者的临床疗效。
2008年1月至2014年1月，360例连续的巨大腰椎间盘突出症患者接受了经皮内镜下腰椎间盘切除术（184例患者）或微创经椎间孔腰椎椎间融合术（176例患者）治疗。前瞻性收集用于分析的数据包括翻修手术后的临床和影像学结果以及并发症。
随访期间，两个治疗组之间的术后数据在术后腿部疼痛的平均总视觉模拟评分、日本骨科学会（JOA）评分和功能障碍指数（ODI）评分方面无显著差异。经皮内镜下腰椎间盘切除术组的恢复率为89.3%，微创经椎间孔腰椎椎间融合术组为93.4%。经皮内镜下腰椎间盘切除术组的满意率为86.3%，微创经椎间孔腰椎椎间融合术组为92.2%。微创经椎间孔腰椎椎间融合术组观察到4例硬脊膜撕裂。经皮内镜下腰椎间盘切除术组有14例患者出现复发，该组1例患者还出现永久性神经功能缺损。微创经椎间孔腰椎椎间融合术组记录到1例术后椎间感染。
经皮内镜下腰椎间盘切除术和微创经椎间孔腰椎椎间融合术治疗巨大腰椎间盘突出症的比较显示，两者均显示出良好的临床疗效，但并发症不同。与微创经椎间孔腰椎椎间融合术相比，经皮内镜下腰椎间盘切除术具有以下优点：（1）在局部麻醉下的可行性；（2）“融合疾病”（如相邻节段退变）的罕见性。然而，经皮内镜下腰椎间盘切除术也显示出一些问题，包括成功率和满意率相对较低、术后长期慢性下腰痛发生率相对较高以及复发可能性，尽管复发机会较低。因此，这两种治疗方法的主要差异与术后并发症以及满意率和恢复率有关。我们建议，未来应开展多中心研究，纳入更多患者，以更好地了解这些并发症的临床相关性。
