Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).
Department of Orthopedics, Nanyang TCM Hospital, Nanyang, Henan, China (mainland).
Med Sci Monit. 2020 Jun 7;26:e922777. doi: 10.12659/MSM.922777.
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has become one of the most popular minimally invasive surgeries for lumbar disc herniation (LDH), however, very highly migrated LDH is still a tricky issue for PELD. This study reported a new endoscopic discectomy strategy for the treatment of very highly migrated LDH between the L4/5 and L5/S1 level. MATERIAL AND METHODS The current study retrospectively analyzed 12 patients who accepted PELD for very highly migrated LDH between the L4/5 and L5/S1 level. Under local anesthesia, the transforaminal approach was chosen for the L4/5 level and the interlaminar approach was chosen for the L5/S1 level. The 10-point visual analogue scale (VAS) was used to assess back pain (VAS-Back) and leg pain (VAS-Leg). Oswestry disability index (ODI) and Modified Mac Nab Criteria were adopted as the functional evaluation methods. All patients were followed in the outpatient department for at least 12 months after their operation. RESULTS Our study showed that very highly migrated disc between L4/5 and L5/S1 level could be removed completely by this strategy. Except for 1 case of postoperative dysesthesia and 1 case of dural tear, no severe complication occurred. At the last follow-up, the average VAS-Back score of the study patients was reduced from 5.17±2.12 to 2.08±1.08 (P<0.05) and the average VAS-Leg score was reduced from 7.25±1.48 to 1.33±0.89 (P<0.05). The average ODI scores improved from 48.50±10.59 to 13.00±2.76 (P<0.05). According to the Modified Mac Nab Criteria, 83.33% of patients (10 out of 12 patients) received an excellent or good recovery and no poor result was reported. No recurrence was observed during follow up. CONCLUSIONS PELD via a transforaminal and interlaminar combined approach provides an alternative option for select patients with very highly migrated LDH between the L4/5 and L5/S1 level.
经皮内窥镜腰椎间盘切除术（PELD）已成为治疗腰椎间盘突出症（LDH）最受欢迎的微创手术之一，然而，对于非常高移位的 LDH，PELD 仍然是一个棘手的问题。本研究报告了一种治疗 L4/5 和 L5/S1 水平之间非常高移位的 LDH 的新内窥镜椎间盘切除术策略。
本研究回顾性分析了 12 例接受 L4/5 和 L5/S1 水平之间非常高移位的 LDH 行 PELD 治疗的患者。在局部麻醉下，选择经椎间孔入路治疗 L4/5 水平，选择经椎板间入路治疗 L5/S1 水平。采用 10 分视觉模拟评分法（VAS）评估腰痛（VAS-Back）和腿痛（VAS-Leg）。采用 Oswestry 功能障碍指数（ODI）和改良 Mac Nab 标准作为功能评估方法。所有患者在术后至少 12 个月在门诊进行随访。
本研究表明，通过这种策略可以完全切除 L4/5 和 L5/S1 水平之间非常高移位的椎间盘。除 1 例术后感觉异常和 1 例硬脊膜撕裂外，无严重并发症发生。末次随访时，研究患者的平均 VAS-Back 评分从 5.17±2.12 降至 2.08±1.08（P<0.05），平均 VAS-Leg 评分从 7.25±1.48 降至 1.33±0.89（P<0.05）。平均 ODI 评分从 48.50±10.59 改善至 13.00±2.76（P<0.05）。根据改良 Mac Nab 标准，83.33%（12 例中有 10 例）的患者获得了优秀或良好的恢复，无不良结果报告。随访期间无复发。
经皮内窥镜下经椎间孔和经椎板间联合入路为 L4/5 和 L5/S1 水平之间非常高移位的 LDH 患者提供了一种替代选择。
