经皮椎间孔镜腰椎间盘切除术与开放腰椎显微切除术的比较：一项 5 年随访的对照队列研究。

Transforaminal Endoscopic Lumbar Discectomy Versus Open Lumbar Microdiscectomy: A Comparative Cohort Study with a 5-Year Follow-Up.

机构信息

Department of Neurosurgery, Gachon University, Gil Medical Center, Republic of Korea.

Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.

出版信息

Pain Physician. 2019 May;22(3):295-304.

DOI:

PMID:31151337

Abstract

BACKGROUND

Transforaminal endoscopic lumbar discectomy (TELD) is regarded as an effective treatment option for soft lumbar disc herniation (LDH). There have been few studies evaluating the long-term outcomes of endoscopic procedures compared with conventional surgery.

OBJECTIVES

The objective of this study was to demonstrate the clinical outcomes of TELD compared with those of open lumbar microdiscectomy.

STUDY DESIGN

Between January 2009 and September 2011, 335 consecutive patients with symptomatic LDH were treated with decompressive discectomy, either TELD or open microdiscectomy. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed.

SETTING

Hospital and outpatient surgical center.

METHODS

Data from 298 patients who were treated with decompressive discectomy, either TELD or open microdiscectomy, were evaluated with a minimum 5-year follow-up period. Among them, 146 patients were treated using TELD (TELD group), and the remaining 152 patients using open microdiscectomy (Open group). Perioperative data and clinical outcomes were evaluated using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the modified Macnab criteria.

RESULTS

The VAS and ODI significantly improved in both groups. The rate of excellent or good outcomes was 88.36% and 87.5% in the TELD and Open group, respectively. The reoperation rate was 4.2% and 3.3% in the TELD and Open group, respectively. There were no significant differences in the clinical outcomes; however, operative time, hospital stay, and time to return to work were significantly shorter in the TELD group (P < 0.01).

LIMITATIONS

First, the patient selection was not randomized; therefore, the risk of bias might be increased. Second, this study lacks analysis of the radiographic changes related to the degenerative change over the long-term follow-up period.

CONCLUSIONS

The long-term results of TELD for soft LDH are comparable to those of conventional open microdiscectomy. The selective endoscopic discectomy technique under local anesthesia provides the typical advantages of minimally invasive procedures such as a shorter operation time, hospital stay, and recovery time.

KEY WORDS

Endoscopic, discectomy, hospital stay, lumbar disc, microscopic, operative time, return to work, transforaminal.

摘要

背景

经皮椎间孔内窥镜腰椎间盘切除术（TELD）被认为是治疗软性腰椎间盘突出症（LDH）的有效方法。与传统手术相比，很少有研究评估内镜手术的长期结果。

目的

本研究旨在展示 TELD 与开放腰椎显微切除术的临床结果。

研究设计

2009 年 1 月至 2011 年 9 月，335 例症状性 LDH 患者接受减压椎间盘切除术，包括 TELD 或开放显微切除术。患者前瞻性地进入临床数据库，并对其记录进行回顾性审查。

设置

医院和门诊外科中心。

方法

对接受减压椎间盘切除术，包括 TELD 或开放显微切除术的 298 例患者的数据进行了评估，随访时间至少为 5 年。其中，146 例患者接受 TELD 治疗（TELD 组），152 例患者接受开放显微切除术（Open 组）。使用视觉模拟评分（VAS）、Oswestry 残疾指数（ODI）和改良 Macnab 标准评估围手术期数据和临床结果。