Mahatthanatrakul Akaworn, Kotheeranurak Vit, Lin Guang-Xun, Hur Jung-Woo, Chung Ho Jung, Kim Jin-Sung
Department of Orthopaedics, Naresuan University Hospital, Phitsanulok, Thailand.
Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand.
Neuroradiology. 2019 Apr;61(4):411-419. doi: 10.1007/s00234-019-02174-4. Epub 2019 Feb 8.
PURPOSE: Postoperative magnetic resonance imaging (MRI) after microdiscectomy for lumbar disc herniation frequently shows spinal canal compression by the remaining annulus, which gradually decreases over time. Transforaminal endoscopic lumbar discectomy (TELD) can remove the herniation with minimal trauma to surrounding soft tissue. We aim to identify this remodeling of annulus fibrosus and the change of disc signal after TELD. METHODS: We reviewed patients who underwent TELD. Clinical data obtained were Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain. Residual mass signal and disc protrusion size were measured in postoperative MRI. RESULTS: Thirty-one patients were reviewed. The mean age was 38.3 ± 14.4 years (range 18 to 76 years). ODI was 18.2% at the first follow-up and 12.7% at the last follow-up (p = 0.009). VAS for back and leg pain were 2.0 and 1.0 without significant change during follow-up. Disc protrusion size was reduced by 67.7% at the 1-year follow-up (p < 0.001). The residual mass signals at postoperative day 1 were high in 12 cases, intermediate in 18 cases, and low in1 case. The signal intensity was correlated with the percentage of disc protrusion reduction (p = 0.048). The percentage of disc protrusion reduction correlated with the last follow-up ODI (p = 0.018). CONCLUSION: One year after TELD, annulus remodeling was observed with an average of 67.7% of size reduction. The high signal intensity of residual mass at day 1 correlated with disc protrusion reduction at follow-up MRI. The percentage of disc protrusion reduction associated with the ODI at the final follow-up.
目的:腰椎间盘突出症行显微椎间盘切除术后的磁共振成像(MRI)常显示剩余纤维环导致椎管受压,且这种情况会随时间逐渐减轻。经椎间孔内镜下腰椎间盘切除术(TELD)能以最小的周围软组织创伤切除突出物。我们旨在确定TELD术后纤维环的重塑情况及椎间盘信号的变化。 方法:我们回顾了接受TELD手术的患者。获取的临床数据包括Oswestry功能障碍指数(ODI)以及背部和腿部疼痛的视觉模拟评分(VAS)。在术后MRI上测量残余肿块信号和椎间盘突出大小。 结果:共回顾了31例患者。平均年龄为38.3±14.4岁(范围18至76岁)。首次随访时ODI为18.2%,末次随访时为12.7%(p = 0.009)。随访期间背部和腿部疼痛的VAS分别为2.0和1.0,无显著变化。1年随访时椎间盘突出大小减少了67.7%(p < 0.001)。术后第1天残余肿块信号高的有12例,中等的有18例,低的有1例。信号强度与椎间盘突出减少百分比相关(p = 0.048)。椎间盘突出减少百分比与末次随访时的ODI相关(p = 0.018)。 结论:TELD术后1年,观察到纤维环重塑,平均大小减少67.7%。术后第1天残余肿块的高信号强度与随访MRI时椎间盘突出减少相关。椎间盘突出减少百分比与最终随访时的ODI相关。
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