Li Xiang, Bai Jinzhu, Hong Yi, Zhang Junwei, Tang Hehu, Lyu Zhen, Liu Shujia, Chen Shizheng, Liu Jiesheng
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center; School of Rehabilitation, Capital Medical University, Beijing, People's Republic of China.
Int J Gen Med. 2021 Mar 5;14:779-785. doi: 10.2147/IJGM.S293400. eCollection 2021.
To investigate the long-term (> 7 years) clinical outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease to address postoperative problems including postoperative dysesthesia (POD), residual back pain and segmental instability.
Inclusion and exclusion criteria were established. All patients who met the above criteria were treated by PELD using the transforaminal approach. Limited discectomy was performed to preserve the disc material in the intervertebral space as much as possible. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back pain (VAS-B) and leg pain (VAS-L) and Modified MacNab's criterion were used for clinical evaluation. Radiographic parameters including height of intervertebral disc and segmental instability were also evaluated.
Forty-two patients (24 men and 18 women) who met our inclusion and exclusion criteria were included in our study. The average follow-up period was 95.71±5.63 months (ranging from 87 to 105 months). There were no neurological complications associated with the operation. POD was found in 14.29% of patients, while only 2 patients (4.76%) complained of mild dysesthesia at final follow-up. Two patients (4.76%) required revision surgery during the follow-up period. The final follow-up ODI, JOA score, VAS-B and VAS-L were significantly better than preoperative values. The average disc-height ratio was 84.52±5.66% of the preoperative disc height. No instability at the operation level was noted at final follow-up.
Our study showed that PELD using the transforaminal approach can provide favorable results after a long-term follow-up period. POD is a common complication at initial prognosis. Limited discectomy can preserve the disc height well and minimize the risk of residual back pain.
探讨经皮内镜下腰椎间盘切除术治疗腰椎退行性疾病的长期（>7年）临床疗效，以解决术后问题，包括术后感觉异常（POD）、残余背痛和节段性不稳。
制定纳入和排除标准。所有符合上述标准的患者均采用经椎间孔入路的经皮内镜下腰椎间盘切除术（PELD）治疗。尽可能保留椎间隙内的椎间盘组织进行有限的椎间盘切除术。采用Oswestry功能障碍指数（ODI）、日本矫形外科学会（JOA）评分、背痛视觉模拟量表（VAS-B）和腿痛视觉模拟量表（VAS-L）以及改良MacNab标准进行临床评估。还评估了包括椎间盘高度和节段性不稳在内的影像学参数。
42例符合纳入和排除标准的患者（24例男性和18例女性）纳入本研究。平均随访时间为95.71±5.63个月（87至105个月）。手术未出现神经并发症。14.29%的患者出现POD，而在末次随访时仅有2例患者（4.76%）主诉轻度感觉异常。2例患者（4.76%）在随访期间需要翻修手术。末次随访时ODI、JOA评分、VAS-B和VAS-L均显著优于术前值。平均椎间盘高度比为术前椎间盘高度的84.52±5.66%。末次随访时未发现手术节段不稳。
我们的研究表明，经椎间孔入路的PELD在长期随访后可提供良好的疗效。POD是初期预后的常见并发症。有限的椎间盘切除术可很好地保留椎间盘高度，并将残余背痛的风险降至最低。
