经皮内镜腰椎间盘切除术治疗开放手术后复发性椎间盘突出症的纵向临床结果。
Longitudinal clinical outcomes after full-endoscopic lumbar discectomy for recurrent disc herniation after open discectomy.
机构信息
Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea.
Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Orthopaedic Surgery and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
J Clin Neurosci. 2020 Feb;72:124-129. doi: 10.1016/j.jocn.2019.12.047. Epub 2020 Jan 13.
OBJECTIVE
Full-endoscopic lumbar discectomy (FELD) is a minimally invasive surgical option for recurrent lumbar disc herniation (LDH). Nonetheless, patients' clinical outcomes may be poorer after surgery for recurrent LDH than for primary LDH. Therefore, we compared patients' longitudinal clinical outcomes after FELD for recurrent LDH or primary LDH.
METHODS
The medical records of patients who underwent FELD for primary LDH (group A) or recurrent LDH (group B) were retrospectively reviewed. The inclusion criteria were: 1) single-level LDH or recurrent LDH at L4-5 or L5-S1, 2) age ≤60 years, 3) previous open discectomy (group B), and 4) ≥6 months of follow-up. In total, 244 patients (group A, 211; group B, 33) were included. Clinical outcomes (Oswestry Disability Index [ODI]; visual analogue pain score for the back and leg [VAS-B] and [VAS-L]) over 24 months of follow-up were compared between groups with a linear mixed-effects model.
RESULTS
All clinical outcomes significantly improved from pre-operation to 3 months postoperatively (p < 0.01), and the improvement was maintained for 24 months postoperatively in both groups. The clinical outcomes of groups A and B were not significantly different during 24 months follow-up (ODI, p = 0.94; VAS-B, p = 0.11; and VAS-L, p = 0.48). The reoperation rate was 3.3% in group A and 3.0% in group B, but the overall complication rate was higher in group B (9.8%) than in group A (6.6%).
CONCLUSION
The longitudinal clinical outcomes after FELD for recurrent LDH may not be poor as feared. However, the higher complication rate in patients undergoing FELD for recurrent LDH should be noted.
目的
全内镜下腰椎间盘切除术（FELD）是治疗复发性腰椎间盘突出症（RLDH）的一种微创选择。然而，复发性 LDH 患者术后的临床疗效可能不如初次 LDH 患者。因此，我们比较了 FELD 治疗复发性 LDH 和原发性 LDH 的患者的纵向临床疗效。
方法
回顾性分析接受 FELD 治疗的原发性 LDH 患者（A 组）和复发性 LDH 患者（B 组）的病历。纳入标准为：1）单节段 LDH 或 L4-5 或 L5-S1 复发性 LDH；2）年龄≤60 岁；3）既往行开放椎间盘切除术（B 组）；4）随访时间≥6 个月。共纳入 244 例患者（A 组 211 例，B 组 33 例）。采用线性混合效应模型比较两组患者 24 个月随访期间的临床疗效（Oswestry 功能障碍指数[ODI]；腰背疼痛视觉模拟评分[VAS-B]和[VAS-L]）。
结果
所有临床疗效指标均在术后 3 个月时与术前相比显著改善（p<0.01），且两组患者在术后 24 个月时均保持改善。两组患者在 24 个月随访期间的临床疗效无显著差异（ODI，p=0.94；VAS-B，p=0.11；VAS-L，p=0.48）。A 组的再次手术率为 3.3%，B 组为 3.0%，但 B 组的总并发症发生率（9.8%）高于 A 组（6.6%）。
结论
FELD 治疗复发性 LDH 的纵向临床疗效可能不像预期的那样差。然而，应注意到复发性 LDH 患者行 FELD 治疗的并发症发生率较高。
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