Yin Guodong, Wang Chong, Liu Shi-Qin
923nd Hospital of People's Liberation Army, Department of Orthopedic Surgery, Nanning, Guangxi, P.R. China.
Turk Neurosurg. 2021;31(6):857-865. doi: 10.5137/1019-5149.JTN.30241-20.4.
To investigate and compare the therapeutic efficiency and radiographic measurement between the transforaminal approach and interlaminar approach in percutaneous endoscopic discectomy.
From January 2017 to January 2018, 86 patients suffering from single lumbar disc herniation were included in this retrospective analysis and divided into the percutaneous endoscopic transforaminal discectomy (PETD) group and percutaneous endoscopic interlaminar discectomy (PEID) group according to different surgical approaches. Data on age, gender, course of the disease, smoking status, and body mass index (BMI) were also obtained. Moreover, lumbar spine X-ray (anterior? posterior, lateral, and excessive flexion and extension), CT scan, and MRI were performed preoperatively for all patients. Another MRI of the lumbar spine was performed within the week after the operation. Clinical efficacy was calculated to assess the clinical effect of the therapy using the visual analogue scale (VAS) and Oswestry Disability Index (ODI) at 1 day before surgery, 3 months after surgery, 1 year after surgery, and the last follow-up visit.
All patients were followed up for above two year. 44 and 42 cases were enrolled, respectively, in the PETD and PEID groups. 62 males and 24 females were included in this study. The mean ages of the PETD and PEID groups were 34.58 ± 6.70 and 33.72 ± 7.12 years, respectively (p=0.763). The symptoms showed evident improvement after surgery, but there were no significant differences regarding VAS scores, ODI scores, spinal canal occupation rate and lumbar lordosis except disc height and pfirrmann grade between the two groups (p > 0.05). The revision surgery rates of the PETD and PEID groups at the last follow-up time were 2.3% and 4.8%, respectively (p=0.612). One patient in the PETD group underwent PEID revision surgery because of residual disk herniation. Re-operation were performed on 2 patients in the PEID group due to recurrencee.
Approaches of the PEID and PETD are pivotal to address lumbar disc herniation (LDH) disease. Selection of surgery approach depends on anatomical structure, physiological characteristic and operative skill of the surgeon.
探讨并比较经椎间孔入路与椎板间入路在经皮内镜下椎间盘切除术的治疗效果及影像学测量结果。
2017年1月至2018年1月，86例单节段腰椎间盘突出症患者纳入本回顾性分析，并根据不同手术入路分为经皮内镜下经椎间孔椎间盘切除术（PETD）组和经皮内镜下椎板间椎间盘切除术（PEID）组。收集患者的年龄、性别、病程、吸烟状况及体重指数（BMI）等资料。此外，所有患者术前均行腰椎X线（正侧位、过伸过屈位）、CT扫描及MRI检查。术后1周内行腰椎MRI复查。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI），分别在术前1天、术后3个月、术后1年及末次随访时计算临床疗效，以评估治疗的临床效果。
所有患者均随访2年以上。PETD组和PEID组分别纳入44例和42例。本研究共纳入62例男性和24例女性。PETD组和PEID组的平均年龄分别为34.58±6.70岁和33.72±7.12岁（p = 0.763）。术后症状均有明显改善，但两组间VAS评分、ODI评分、椎管占位率及腰椎前凸度，除椎间盘高度和Pfirrmann分级外差异均无统计学意义（p＞0.05）。PETD组和PEID组末次随访时的翻修手术率分别为2.3%和4.8%（p = 0.612）。PETD组1例患者因残留椎间盘突出接受PEID翻修手术。PEID组2例患者因复发接受再次手术。
PEID和PETD入路是治疗腰椎间盘突出症（LDH）的关键。手术入路的选择取决于外科医生的解剖结构、生理特征及手术技巧。
