Beck Joel, Westin Olof, Klingenstierna Mikael, Baranto Adad
Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
Int J Spine Surg. 2020 Aug;14(4):563-570. doi: 10.14444/7075. Epub 2020 Jul 31.
The introduction of full-endoscopic lumbar discectomy (FELD) procedures has made it possible to challenge microscopic discectomy as the gold standard method to treat lumbar disc herniations.
The aim of the present study is to investigate the introductory-phase postoperative clinical improvement for FELD patients regarding leg pain, patient-reported outcome measurements (PROMs), complications, reoperations, and learning curve analysis.
All patients who underwent FELD at Sahlgrenska University Hospital, Sweden, were prospectively included during 2013- 2017. A total of 92 patients were enrolled and followed up for 1 year. The characteristics of the study population, degree of leg pain, complications, learning curve, and PROMs were retrieved from patient records and the National Quality Register for Spine Surgery (Swespine).
The postoperative results demonstrated major improvements; leg pain measured by a numerical rating scale (0-10) decreased from 7.4 ± 2.25 to 2.76 ± 2.70, with a mean improvement of -4.54, (-3.62-5.46) 95% confidence interval (CI). The Oswestry Disability Index decreased by 30.48 (-36.27-23.73) with a 95% CI, and the EuroQol-5D increased by 0.39 (0.21-0.57) 95% CI. An assessment of the final surgical result showed that 91.6% ranked their general situation as better or much better. Specifically, regarding postoperative leg pain, 87% regarded their leg pain as completely gone, much better, or somewhat better, while 13% regarded their leg pain as unchanged or worse. A learning curve analysis showed that for every 10th FELD procedure performed; the duration of surgery decreased by 2 minutes.
In our study, the introduction of FELD as a safe, quick procedure for the treatment of lumbar disc herniations can yield significant gains in patient-reported outcome measurements and pain reduction. The rate of recurrence and complications is comparable to that of standard surgery.
全内镜下腰椎间盘切除术（FELD）的引入使得挑战将显微椎间盘切除术作为治疗腰椎间盘突出症的金标准方法成为可能。
本研究的目的是调查FELD患者术后初期在腿痛、患者报告结局测量（PROMs）、并发症、再次手术以及学习曲线分析方面的临床改善情况。
2013年至2017年期间，前瞻性纳入了瑞典萨尔格伦斯卡大学医院所有接受FELD手术的患者。共纳入92例患者并随访1年。从患者记录和国家脊柱手术质量登记处（Swespine）获取研究人群的特征、腿痛程度、并发症、学习曲线和PROMs。
术后结果显示有显著改善；用数字评分量表（0 - 10）测量的腿痛从7.4±2.25降至2.76±2.70，平均改善-4.54，95%置信区间（CI）为（-3.62 - 5.46）。Oswestry功能障碍指数降低了30.48（95%CI为-36.27 - 23.73），欧洲五维健康量表（EuroQol - 5D）提高了0.39（95%CI为0.21 - 0.57）。对最终手术结果的评估显示，91.6%的患者将其总体状况评为较好或好得多。具体而言，关于术后腿痛，87%的患者认为他们的腿痛完全消失、好得多或有所好转，而13%的患者认为他们的腿痛没有变化或更糟。学习曲线分析表明，每进行第10例FELD手术，手术时间减少2分钟。
在我们的研究中，引入FELD作为一种安全、快速治疗腰椎间盘突出症的方法，在患者报告结局测量和疼痛减轻方面可取得显著成效。复发率和并发症发生率与标准手术相当。
