Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France.
Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
Neuroradiology. 2021 Jul;63(7):1135-1143. doi: 10.1007/s00234-021-02633-x. Epub 2021 Mar 30.
To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment.
A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure.
Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers.
APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.
在 CT 和透视引导下评估自动经皮腰椎间盘切除术（APLD）的技术疗效、安全性和可重复性，以治疗对保守治疗无反应的腰椎间盘突出症引起的神经根病。
在一项在三个国家的四个中心进行的前瞻性多中心研究中，对 77 例有症状的腰椎间盘突出症患者采用 APLD 进行治疗。在术前和术后均使用磁共振成像和/或计算机断层扫描来评估椎间盘突出症。这些手术仅使用局部麻醉。临床结果采用视觉模拟评分（VAS）在术后 1 个月和 6 个月时评估疼痛。
技术成功率为 100%，平均介入时间为 30 分钟（15-45 分钟）。手术过程中无并发症发生。3 例患者在术后出现腰椎穿刺后综合征，通过使用血补丁成功治疗。VAS 从干预前的 8 分降至 1 个月后的 3 分（p 值=0.001）。对镇痛的需求从 100%降至 27%。各中心之间的结果无统计学差异。
在局部麻醉下进行双影像引导的 APLD 是一种安全、可行且可重复的技术，可用于治疗有症状的腰椎间盘突出症。
