Bae Junseok, Kim Jisang, Lee Sang-Ho, Kim Jin-Sung
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Neurospine. 2022 Sep;19(3):555-562. doi: 10.14245/ns.2244294.147. Epub 2022 Sep 30.
To evaluate the clinical outcomes of transforaminal endoscopic thoracic discectomy (TETD) and microscopic discectomy (MD) for the treatment of symptomatic thoracic disc herniation (TDH).
Seventy-seven patients (mean, 55.9 years; follow-up, 11.2 months) with symptomatic TDH were retrospectively reviewed (39 TETD and 38 MD). Radiological factors and perioperative outcomes were reviewed. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association impairment scale were used to evaluate clinical and functional outcomes. Patient satisfaction was evaluated using modified MacNab criteria.
The levels of surgery and the location of hernia were evenly distributed in the both groups. The operative time (70.6 minutes vs. 175.7 minutes), estimated blood loss (3.8 mL vs. 357.4 mL), and length of hospital stay (7.0 days vs. 13.0 days) were significantly different between the TETD and MD groups (p < 0.05). VAS scores for dorsal back pain and ODI scores were significantly improved in both groups (p < 0.05). Patients who underwent TETD tended to be more satisfied with the outcome in terms of the modified MacNab criteria (89.7% vs. 73.0%, p = 0.059). Two patients in the MD group underwent revision surgery, whereas one patient in the TETD group underwent MD because of incomplete decompression.
TETD for the symptomatic TDH is a feasible and safe procedure that could be used for a wider range of surgical levels with a shorter operative time and hospital stay and less blood loss. While achieving similar outcomes, TETD achieved better patient satisfaction because of the use of local anesthesia and its minimal invasiveness.
评估经椎间孔内镜下胸椎椎间盘切除术（TETD）和显微椎间盘切除术（MD）治疗症状性胸椎间盘突出症（TDH）的临床疗效。
回顾性分析77例症状性TDH患者（平均年龄55.9岁；随访11.2个月）（39例行TETD，38例行MD）。评估影像学因素和围手术期结果。采用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和美国脊髓损伤协会损伤分级来评估临床和功能结果。使用改良MacNab标准评估患者满意度。
两组手术节段和疝的位置分布均匀。TETD组与MD组的手术时间（70.6分钟对175.7分钟）、估计失血量（3.8毫升对357.4毫升）和住院时间（7.0天对13.0天）有显著差异（p<0.05）。两组患者的背部疼痛VAS评分和ODI评分均有显著改善（p<0.05）。根据改良MacNab标准，接受TETD的患者对结果的满意度更高（89.7%对73.0%，p=0.059）。MD组有2例患者接受了翻修手术，而TETD组有1例患者因减压不彻底而接受了MD手术。
对于症状性TDH，TETD是一种可行且安全的手术方法，可用于更广泛的手术节段，手术时间更短，住院时间更短，失血量更少。在取得相似结果的同时，由于采用局部麻醉及其微创性，TETD获得了更好的患者满意度。
