Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China.
Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China.
World Neurosurg. 2020 Jun;138:e665-e673. doi: 10.1016/j.wneu.2020.03.048. Epub 2020 Mar 16.
Discal cyst is very rare and can cause intractable low back pain and radiating leg pain. Symptoms are hard to distinguish from lumbar disc herniation. The best treatment for discal cyst is controversial. Most lumbar discal cysts are treated surgically, while most studies of percutaneous transforaminal endoscopic surgery are case reports. This study investigated the clinical value of percutaneous transforaminal endoscopic surgery for lumbar discal cyst.
A retrospective study was conducted in 9 patients with a discal cyst from June 2016 to November 2018. All patients had been treated by percutaneous transforaminal endoscopic surgery via a superior vertebral pedicle notch approach. Surgical outcomes were evaluated preoperatively and postoperatively using a visual analog scale for leg pain and the Oswestry Disability Index. At the final follow-up, patients were evaluated for clinical efficacy using modified Macnab criteria.
All 9 patients had remission of symptoms after removal of discal cysts. Postoperative magnetic resonance imaging showed that all patients had complete excision of discal cysts and complete decompression of the treated segment. There were no recurrent lesions during follow-up. Mean operative time was 68.67 ± 14.02 minutes. Mean hospitalization time was 4.22 ± 1.64 days. Preoperative visual analog scale and Oswestry Disability Index score improved significantly after surgery. Visual analog scale leg score improved from 7.88 ± 1.05 preoperatively to 1.78 ± 0.66 at final follow-up (P < 0.05), and ODI score improved from 53.65 ± 12.46 to 16.25 ± 8.76 (P < 0.05). According to the modified Macnab criteria, 5 patients (55.6%) were rated excellent, 3 patients (33.3%) were rated good, and 1 patient (11.1%) was rated fair at final follow-up, with an overall excellent and good rate of 88.9%. There were no serious complications during follow-up.
Percutaneous transforaminal endoscopic surgery could be a safe, minimally invasive surgical treatment for discal cyst, particularly suitable for patients who cannot undergo general anesthesia.
椎间盘囊肿非常罕见，可引起难治性腰痛和放射状腿痛。其症状难以与腰椎间盘突出症相区别。椎间盘囊肿的最佳治疗方法存在争议。大多数腰椎间盘囊肿采用手术治疗，而经皮经椎间孔内窥镜手术的大多数研究都是病例报告。本研究探讨了经皮经椎间孔内窥镜手术治疗腰椎间盘囊肿的临床价值。
回顾性分析 2016 年 6 月至 2018 年 11 月期间采用经皮经椎间孔内窥镜手术通过上椎弓根切迹入路治疗的 9 例椎间盘囊肿患者。所有患者均采用经皮经椎间孔内窥镜手术治疗。采用视觉模拟评分法（VAS）评估腿痛，采用 Oswestry 功能障碍指数（ODI）评估术前和术后的手术结果。末次随访时，采用改良 Macnab 标准评估临床疗效。
所有 9 例患者均在切除椎间盘囊肿后症状缓解。术后磁共振成像显示所有患者均完全切除椎间盘囊肿，治疗节段完全减压。随访期间无复发病例。手术时间平均为 68.67 ± 14.02 分钟。平均住院时间为 4.22 ± 1.64 天。术后 VAS 腿痛评分和 ODI 评分均显著改善。VAS 腿痛评分由术前的 7.88 ± 1.05 分改善至末次随访时的 1.78 ± 0.66 分（P < 0.05），ODI 评分由术前的 53.65 ± 12.46 分改善至末次随访时的 16.25 ± 8.76 分（P < 0.05）。末次随访时，根据改良 Macnab 标准，5 例（55.6%）患者评定为优，3 例（33.3%）患者评定为良，1 例（11.1%）患者评定为可，优良率为 88.9%。随访期间无严重并发症。
经皮经椎间孔内窥镜手术治疗椎间盘囊肿安全、微创，特别适用于不能接受全身麻醉的患者。
