Kang Min-Seok, Park Hyun-Jin, You Ki-Han, Choi Dae-Jung, Park Chang-Won, Chung Hoon-Jae
Department of Orthopedic Surgery, Spine Center, Bumin Hospital Seoul, Seoul, Korea.
Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Global Spine J. 2023 Sep;13(7):1918-1925. doi: 10.1177/21925682211068088. Epub 2022 Feb 18.
Retrospective study.
To compare the clinical outcomes of the biportal endoscopic technique for primary lumbar discectomy (BE-LD) and revision lumbar discectomy (BE-RLD).
Eighty-one consecutive patients who underwent BE-LD or BE-RLD, and could be followed up for at least 12 months were divided into two groups: Group A (BE-LD; n = 59) and Group B (BE-RLD; n = 22). Clinical outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab's criteria. Perioperative results included operation time (OT), length of hospital stay (LOS), amount of surgical drain, and kinetics of serum creatine phosphokinase (CPK) and C-reactive protein (CRP). Clinical and perioperative outcomes were assessed preoperatively and postoperatively at 2 days and at 3, 6, and 12 months. Postoperative complications were noted.
Both groups showed significant improvement in pain (VAS) and disability (ODI) compared to baseline values at postoperative day 2, which lasted until the final follow-up. There were no significant differences in the improvement of the VAS and ODI scores between the groups. According to the modified MacNab's criteria, 88.1 and 90.9% of the patients were excellent or good in groups A and B, respectively. OT, LOS, amount of surgical drain, and kinetics in serum CRP and CPK levels were comparable. Complications in Group A included incidental durotomy (n = 2), epidural hematoma (n = 1), and local recurrence (n = 1) and in Group B incidental durotomy (n = 1) and epidural hematoma (n = 1).
BE-RLD showed favorable clinical outcomes, less postoperative pain, and early laboratory recovery equivalent to BE-LD.
回顾性研究。
比较双孔道内镜技术用于初次腰椎间盘切除术（BE-LD）和翻修腰椎间盘切除术（BE-RLD）的临床疗效。
81例连续接受BE-LD或BE-RLD且至少随访12个月的患者被分为两组：A组（BE-LD；n = 59）和B组（BE-RLD；n = 22）。临床疗效包括视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和改良MacNab标准。围手术期结果包括手术时间（OT）、住院时间（LOS）、手术引流量以及血清肌酸磷酸激酶（CPK）和C反应蛋白（CRP）的变化情况。在术前、术后2天以及术后3、6和12个月评估临床和围手术期结果。记录术后并发症。
与术后第2天的基线值相比，两组患者的疼痛（VAS）和功能障碍（ODI）均有显著改善，且持续至末次随访。两组间VAS和ODI评分的改善情况无显著差异。根据改良MacNab标准，A组和B组分别有88.1%和90.9%的患者疗效为优或良。OT、LOS、手术引流量以及血清CRP和CPK水平的变化情况具有可比性。A组并发症包括意外硬脊膜切开（n = 2）、硬膜外血肿（n = 1）和局部复发（n = 1），B组并发症包括意外硬脊膜切开（n = 1）和硬膜外血肿（n = 1）。
BE-RLD显示出良好的临床疗效，术后疼痛较轻，实验室指标恢复较早，与BE-LD相当。
