Department of Neurosurgery, Busan Wooridul Spine Hospital (WSH), Busan, Korea.
Department of Neurosurgery, Wooridul Spine Hospital (WSH) Dongrae, Busan, Korea.
Pain Physician. 2020 Jul;23(4):393-404.
Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
This study used a retrospective design.
Research was conducted in a hospital and outpatient surgical center.
This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data.
Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD.
The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection.
In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011.
Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.
经皮内窥镜腰椎间盘切除术（PELD）或经皮内窥镜腰椎间盘切除术已被报道对退行性脊椎滑脱症的椎间盘突出症有效。很少有研究调查过开放式腰椎显微切除术（OLM）和 PELD 治疗前、后脊椎滑脱伴轻度滑移和不稳定的疗效。
我们旨在评估 OLM 和 PELD 治疗前、后脊椎滑脱伴轻度滑移和不稳定的疗效。
本研究采用回顾性设计。
在医院和门诊外科中心进行。
本研究纳入了 20 至 60 岁的低等级退行性脊椎滑脱患者，他们于 2007 年 3 月至 2014 年 8 月在我院接受 OLM 或 PELD 治疗，用于前、后脊椎滑脱。所有患者均至少随访 3 年。我们进行了电话调查和图表审查，重点关注术前和术后的影像学参数。此外，我们邀请患者进行复查，以更新他们的临床和影像学数据。
OLM 组和 PELD 组分别在平均 71.44 个月和 74.69 个月进行了电话调查和临床/影像学评估。在接受 OLM 治疗的 43 例患者中，34 例患者接受了电话调查，其中 17 例接受了复查。在接受 PELD 治疗的 41 例患者中，32 例接受了电话调查，其中 19 例接受了复查。根据电话调查和患者病历，OLM 组有 8 例（23.5%）和 1 例（4.4%）患者在同一椎体水平行再次手术，OLM 组的再次手术率明显更高（P=0.028）。OLM 术后椎间盘高度降低较 PELD 更为明显。与 PELD 相比，OLM 与更高的医源性终板损伤、终板缺损评分和软骨下骨信号强度改变发生率相关。然而，OLM 和 PELD 的最终临床结果无差异。
本研究的局限性包括样本量相对较小，以及由于非随机患者选择而可能存在偏倚。
对于有腰椎间盘突出症的脊椎滑脱症患者，如果存在轻度不稳定的椎间盘突出症，PELD 可能是一种降低复发率和减缓椎间盘退变的良好治疗选择。IRB 批准号：2016-12-WSH-011。
前脊椎滑脱、椎间盘退变、终板、腰椎间盘突出症、开放式腰椎切除术、经皮内窥镜腰椎切除术、后脊椎滑脱、滑移。
