Nanoori Gangnam Hospital, Seoul, Spine Surgery, Republic of South Korea.
Nanoori Gangnam Hospital, Seoul, Spine Surgery, Republic of South Korea.
World Neurosurg. 2021 Apr;148:e101-e114. doi: 10.1016/j.wneu.2020.12.176. Epub 2021 Jan 11.
OBJECTIVE: Postoperative dysesthesia (POD) is a common complication in surgery involving foraminal diseases, including lumbar foraminal or extraforaminal herniated nucleus pulposus (HNP). Minimal dorsal root ganglion (DRG) retraction is key to preventing POD. We compared the clinical results, safety, and efficacy between the paraspinal transforaminal approach requiring DRG retraction and the interlaminar contralateral approach without DRG retraction for foraminal and extraforaminal diseases. METHODS: A retrospective cohort study was performed of 50 patients who underwent uniportal transforaminal endoscopic lumbar foraminotomy and discectomy (TELD) and 50 patients who underwent anuniportal interlaminar contralateral endoscopic lumbar foraminotomy and discectomy (ICELF) because of lumbar foraminal HNP. The operated levels, combined degenerative diseases, postoperative complications, and POD were analyzed. The visual analog scale (VAS) pain scores, modified Oswestry Disability Index, and MacNab criteria for evaluating pain disability and response were analyzed. RESULTS: In the ICELF group (total, n = 7, 14%), there were 5 (10%) and 2 (4%) patients with POD grade 1 and 2, respectively. In the TELD group (total, n = 13, 26%), there were 7 (14%), 5 (10%), and 1 (2%) patients with POD grade 1, 2, and 3, respectively. The overall occurrence rate of grade 2 and greater POD was higher in the TELD group (n = 6, 12%) than in the ICELF group (n = 2, 4%). In the ICELF group, 3 of 9 patients (33%) with combined canal structure deforming diseases had POD, of whom none had POD of grade 2 and greater. In the TELD group, 4 of 7 patients (57%) with combined canal structure deforming diseases had POD, of whom all had POD of grade 2 and greater. Two surgical groups showed favorable clinical outcomes with the visual analog scale, Oswestry Disability Index, and MacNab criteria. CONCLUSIONS: Both TELD and ICELF were found to treat foraminal or extraforaminal HNP with good clinical outcomes. ICELF might have a lower POD rate in complicated cases such as adjacent segment disease, degenerative spondylolisthesis, and isthmic spondylolisthesis. This surgical procedure could be an alternative in complicated cases or in patients with an anatomically limited L5-S1 level. However, the procedure is technically challenging to perform.
目的：术后感觉异常（POD）是涉及孔疾病的手术的常见并发症，包括腰椎孔或外侧孔突出的核髓（HNP）。最小的背根神经节（DRG）回缩是预防 POD 的关键。我们比较了经皮椎间孔内窥镜腰椎孔切开术和椎间盘切除术（TELD）和单侧经椎间孔对侧内窥镜腰椎孔切开术和椎间盘切除术（ICELF）治疗孔和外侧孔疾病的临床效果、安全性和疗效。
方法：回顾性队列研究了 50 例因腰椎孔 HNP 接受单通道经皮椎间孔内窥镜腰椎孔切开术和椎间盘切除术（TELD）和 50 例接受单侧经椎间孔对侧内窥镜腰椎孔切开术和椎间盘切除术（ICELF）的患者。分析了手术水平、合并退行性疾病、术后并发症和 POD。分析了视觉模拟评分（VAS）疼痛评分、改良 Oswestry 残疾指数和 MacNab 标准评估疼痛残疾和反应。
结果：在 ICELF 组（总数，n=7，14%）中，有 5 例（10%）和 2 例（4%）患者分别为 POD 1 级和 2 级。在 TELD 组（总数，n=13，26%）中，有 7 例（14%）、5 例（10%）和 1 例（2%）患者分别为 POD 1 级、2 级和 3 级。TELD 组（n=6，12%）2 级及以上 POD 总发生率高于 ICELF 组（n=2，4%）。在 ICELF 组中，9 例（33%）合并椎管结构变形疾病的患者中有 3 例发生 POD，均无 2 级及以上 POD。在 TELD 组中，7 例（57%）合并椎管结构变形疾病的患者中有 4 例发生 POD，均为 2 级及以上 POD。两组手术均取得了良好的临床效果，VAS、Oswestry 残疾指数和 MacNab 标准。
结论：TELD 和 ICELF 均被发现可治疗孔或外侧孔 HNP，具有良好的临床效果。ICELF 在治疗相邻节段疾病、退行性滑脱和峡部裂性滑脱等复杂病例时，可能具有较低的 POD 发生率。这种手术方法可能是复杂病例或解剖学上有限的 L5-S1 水平患者的另一种选择。然而，该手术操作具有一定的技术挑战性。
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