全内镜脊柱手术治疗高位移行型腰椎间盘突出症的功能结局：一项基于前瞻性登记的队列研究，随访时间超过 5 年。

Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up.

机构信息

College of Medicine, Taipei Medical University, Taipei, Taiwan.

Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

出版信息

BMC Musculoskelet Disord. 2021 Jan 9;22(1):58. doi: 10.1186/s12891-020-03891-1.

DOI:10.1186/s12891-020-03891-1

PMID:33422040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7797117/

Abstract

BACKGROUND

Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a high-grade migrated herniated disc. However, because of the complexity of the surgery, success is dependent on the surgeon's skill. Therefore, patients are frequently treated using open discectomy. Anatomical constraints and technical difficulties can lead to the incomplete removal of high-grade migrated discs.

METHODS

We retrospectively reviewed patients who had undergone FELD performed by a single surgeon between January 2010 and January 2014 from a prospective spine registry in an institute. Perioperative records and data of the Oswestry Disability Index, visual analog scale scores (preoperatively and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years after the operation), and MacNab criteria were collected.

RESULTS

Of 58 patients with a follow-up duration of > 5 years, (41 and 17 patients had undergone transforaminal endoscopic lumbar discectomy [TELD] and interlaminar endoscopic lumbar discectomy [IELD], respectively), the satisfaction rate was 87.8% (five unsatisfactory cases) for TELD and 100% for IELD. The overall percentage of patients with good to excellent results according to modified MacNab criteria was 91.3% (53/58 patients). Two patients had residual discs. Two patients needed an open discectomy due to recurrent disc herniation. One IELD patient received spinal fusion surgery due to segmental instability after 5 years.

CONCLUSION

FELD has a high success rate for the management of high-grade migrated herniated discs. In patients with high-grade disc migration from L1 to L5, TELD is effective and safe. However, for L4-L5 and L5-S1 high-grade upward and downward disc migration, IELD is the favorable option and provides high patient satisfaction.

摘要

背景

全内镜下腰椎间盘切除术（FELD）是治疗高位移行型椎间盘突出症的一种替代后路开放性手术的方法。然而，由于手术的复杂性，手术的成功与否取决于外科医生的技术。因此，患者经常接受开放性椎间盘切除术治疗。解剖学限制和技术困难可能导致高位移行型椎间盘不能完全切除。

方法

我们回顾性分析了 2010 年 1 月至 2014 年 1 月期间，在一家研究所的前瞻性脊柱登记处，由同一位外科医生行 FELD 治疗的患者。收集了围手术期记录和 Oswestry 功能障碍指数、视觉模拟评分（术前及术后 2 周、6 周、3 个月、6 个月、1 年、2 年和 5 年）和 MacNab 标准的数据。

结果

在 58 例随访时间>5 年的患者中（41 例和 17 例分别接受了经椎间孔内镜腰椎间盘切除术[TELD]和经椎板间内镜腰椎间盘切除术[IELD]），TELD 的满意度为 87.8%（5 例不满意），而 IELD 的满意度为 100%。根据改良 MacNab 标准，良好至优秀结果的患者总体百分比为 91.3%（53/58 例）。2 例患者有残留椎间盘。2 例因椎间盘突出复发需要行开放性椎间盘切除术。1 例 IELD 患者在 5 年后因节段性不稳定接受脊柱融合手术。