Yoshikane Koichi, Kikuchi Katsuhiko, Izumi Teiyu, Okazaki Ken
Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Spine Surg Relat Res. 2020 Nov 20;5(4):272-277. doi: 10.22603/ssrr.2020-0159. eCollection 2021.
Revision surgery for recurrent lumbar disc herniation after surgical treatment is at times challenging due to epidural adhesions and scar. This study aimed to review the clinical results and safety of full-endoscopic lumbar discectomy via interlaminar (FELD-IL) and transforaminal (FELD-TF) approaches for revision surgery.
We conducted a retrospective study including 52 lumbar disc herniation revision patients (mean age, 51.8 years; male/female, 13/39), with 17 FELD-IL and 35 FELD-TF cases. Complication incidences were assessed by reviewing surgical videos and postoperative magnetic resonance images of nerve decompression outcomes. Patients' responses to Japan Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and numerical rating scales (NRS) for lumbar pain, leg pain, and leg numbness were recorded before and during follow-up. The Wilcoxon-signed rank tests were utilized to compare pre- and postoperative group variables.
The average operation time was 33.0 min in FELD-IL and 31.7 min in FELD-TF. Seven FELD-IL cases required lamina excavation with high-speed drill bars for scar tissue dissection from the lamina. Dura injury occurred during the excavation in one case. No complication was noted in the FELD-TF group. Successful decompression of the nerve was achieved in all cases. Complete sets of JOABPEQ and NRS were obtained in 64.5% of FELD-IL and in 82.9% of FELD-TF. The mean follow-up period was 18.6 months. All the subdomain of JOABPEQ and NRS improved significantly postoperative in both groups. There was no difference regarding the improvement of scores between the procedures except NRS for lumbar pain, which was more favorable in FELD-IL. Recurrence of herniation occurred in one patient (6%) after FELD-IL and two patients (6%) after FELD-TF.
Both FELD-IL and FELD-TF are safe and effective revision procedures for recurrent lumbar disc herniation. FELD-TF could be performed employing the same procedure as primary surgery in revisions, regardless of the previous surgical approach.
由于硬膜外粘连和瘢痕形成，腰椎间盘突出症手术治疗后复发的翻修手术有时具有挑战性。本研究旨在回顾经椎板间（FELD-IL）和经椎间孔（FELD-TF）入路的全内镜下腰椎间盘切除术用于翻修手术的临床结果和安全性。
我们进行了一项回顾性研究，纳入52例腰椎间盘突出症翻修患者（平均年龄51.8岁；男/女，13/39），其中17例采用FELD-IL，35例采用FELD-TF。通过回顾手术视频和术后神经减压结果的磁共振图像来评估并发症发生率。记录患者在随访前和随访期间对日本骨科协会背痛评估问卷（JOABPEQ）以及腰椎疼痛、腿痛和腿部麻木的数字评分量表（NRS）的反应。采用Wilcoxon符号秩检验比较术前和术后组变量。
FELD-IL组平均手术时间为33.0分钟，FELD-TF组为31.7分钟。17例FELD-IL病例中有7例需要使用高速钻杆进行椎板切除以从椎板上剥离瘢痕组织。其中1例在切除过程中发生硬脊膜损伤。FELD-TF组未观察到并发症。所有病例均成功实现神经减压。FELD-IL组64.5%、FELD-TF组82.9%获得了完整的JOABPEQ和NRS数据。平均随访期为18.6个月。两组术后JOABPEQ和NRS的所有子领域均有显著改善。除腰椎疼痛的NRS评分外，两种手术方法在评分改善方面无差异，FELD-IL组的腰椎疼痛NRS评分更优。FELD-IL术后有1例患者（6%）、FELD-TF术后有2例患者（6%）出现椎间盘突出复发。
FELD-IL和FELD-TF都是复发性腰椎间盘突出症安全有效的翻修手术方法。无论先前的手术入路如何，FELD-TF在翻修手术中可采用与初次手术相同的操作方法。
