Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
Gachon University College of Medicine, Incheon, South Korea.
Pain Physician. 2021 Jul;24(4):E467-E475.
Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level.
We compared the clinical, surgical, and radiological outcomes of patients with disc herniation at the L5-S1 level who underwent either PEILD, or OLM, performed by a single surgeon with novice-level proficiency.
Observational, retrospective matched cohort design.
An analysis of clinical data was performed at a single center, collected from September 2012 to August 2016.
The study enrolled 56 patients who underwent discectomy at the L5-S1 level, with a minimum one-year follow-up. Patients were allocated to 2 groups: a PEILD group (n = 27; September 2014 to August 2016), or an OLM group (n = 29; September 2012 to August 2014). Clinical, surgical, and radiological outcomes were retrospectively evaluated.
Baseline characteristics including age, gender, past medical history, body mass index, preoperative symptom, and preoperative radiological findings did not differ significantly between the groups. Further, overall clinical outcomes including back and leg pain; surgical outcomes including blood loss, complication rate, and recurrence rate; and radiological outcomes including degree of decompression, disc height, and sagittal alignment were not different significantly between the 2 groups.However, the PEILD group showed significant advantages including lower immediate postoperative back pain (mean 1.44 [95% confidence interval (CI), 1.16-1.72] versus 2.41 [95% CI, 2.14-2.69], P < 0.001), favorable immediate postoperative Odom's criteria (excellent 57.14% versus 24.14%, P = 0.025), shorter operation time (mean 63.89 ±17.99 minutes versus 109.66 ±31.42 minutes, P < 0.001), shorter hospital stay (3.15 [95% CI, 2.21-4.09] days versus 5.72 [95% CI, 3.29-8.16] days, P < 0.001), and rapid return to work (15.67 [95% CI, 12.64-18.69] days versus 24.31 [95% CI ,19.97-28.65] days, P = 0.001).
Due to its retrospective nature, it was not possible to control for all variations. Moreover, the number of patients in the final cohort was relatively small.
Our findings indicate that the PEILD group achieved better perioperative outcomes despite no significant intergroup difference in mid-term clinical and radiological outcomes.
尽管有许多研究比较了全内镜脊柱手术和开放脊柱手术，但很少有研究比较经皮内镜椎间孔腰椎间盘切除术（PEILD）和开放腰椎间盘切除术（OLM）在 L5-S1 水平的结果。
我们比较了由一位经验有限的外科医生进行的 L5-S1 水平椎间盘突出症患者接受 PEILD 或 OLM 的临床、手术和影像学结果。
观察性、回顾性匹配队列设计。
在一个中心进行了临床数据分析，数据收集时间为 2012 年 9 月至 2016 年 8 月。
这项研究纳入了 56 名在 L5-S1 水平接受椎间盘切除术的患者，随访时间至少为 1 年。患者被分为两组：PEILD 组（n = 27；2014 年 9 月至 2016 年 8 月）或 OLM 组（n = 29；2012 年 9 月至 2014 年 8 月）。回顾性评估临床、手术和影像学结果。
两组的基线特征（包括年龄、性别、既往病史、体重指数、术前症状和术前影像学发现）无显著差异。此外，两组的总体临床结果（包括腰背疼痛）、手术结果（包括出血量、并发症发生率和复发率）和影像学结果（包括减压程度、椎间盘高度和矢状面排列）均无显著差异。然而，PEILD 组具有明显优势，包括术后即刻腰背疼痛明显减轻（平均 1.44[95%置信区间（CI），1.16-1.72]vs.2.41[95%CI，2.14-2.69]，P<0.001）、即刻术后 Odom 优良率更高（57.14%vs.24.14%，P=0.025）、手术时间更短（平均 63.89±17.99 分钟 vs.109.66±31.42 分钟，P<0.001）、住院时间更短（3.15[95%CI，2.21-4.09]天 vs.5.72[95%CI，3.29-8.16]天，P<0.001）和更快恢复工作（15.67[95%CI，12.64-18.69]天 vs.24.31[95%CI，19.97-28.65]天，P=0.001）。
由于其回顾性，无法控制所有变异。此外，最终队列中的患者数量相对较少。
尽管在中期临床和影像学结果方面没有显著的组间差异，但我们的研究结果表明，PEILD 组在围手术期结果方面取得了更好的效果。
