Department of Surgery, Tri-Service General Hospital Songshan Branch, National, Defense Medical Center, Taiwan, R.O.C.
Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taiwan, R.O.C.
Medicine (Baltimore). 2023 Feb 3;102(5):e32832. doi: 10.1097/MD.0000000000032832.
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
脊柱解剖异常对经皮内窥镜腰椎间盘切除术（PELD）治疗椎间盘突出症的疗效的影响尚不清楚。本回顾性研究旨在评估 PELD 治疗 L5-S1 椎间盘突出症的安全性和有效性，该研究涵盖了多种特征，并确定腰骶移行椎（LSTV）解剖异常的发生率，以方便术前规划。2005 年 7 月至 2019 年 6 月，对 345 例 L5-S1 椎间盘突出症患者行 PELD 治疗。主要结果是术后 1 年时的腰痛和下肢痛视觉模拟评分。次要结果包括手术入路、腰骶骨异常、椎间盘破裂或严重钙化、小儿腰椎间盘突出症、复发性椎间盘突出症的处理以及长期结果。大多数患者的视觉模拟评分在手术后均显著改善。腰椎骶化的 LSTV 发生率为 4.05%（14/345 例），骶骨腰椎化的发生率为 7.53%（26/345 例）。破裂和严重钙化的椎间盘的发生率分别为 18.55%（64/345）和 5.79%（20/345）。小儿腰椎间盘突出症的发生率为 2.02%（7/345）。复发率为 4.34%（15/345）。报告了 2 例无后遗症的硬脊膜切开术和 8 例术后下肢感觉异常持续超过 3 个月的病例。PELD 治疗 L5-S1 椎间盘突出症安全有效，包括伴有钙化性腰椎间盘突出症、椎间盘破裂伴移位以及 LSTV 存在的病例。术前进行适当的影像学检查对于确定特定病例的因素（包括常见的 LSTV 解剖异常）至关重要。
