Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, China.
Orthopaedic Department, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China.
Orthop Surg. 2023 Jul;15(7):1749-1755. doi: 10.1111/os.13725. Epub 2023 May 26.
Treatment of adjacent segment disease (ASD) is still controversial. The aim of this study was to evaluate the short-term efficacy and safety and to analyze the technical advantages, surgical approach, and indications of percutaneous full endoscopic lumbar discectomy (PELD) in the treatment of ASD after lumbar fusion in elderly patients.
A retrospective of 32 patients with symptomatic ASD were accepted for PELD from October 2017 to January 2020. All patients used the transforaminal approach and recorded the operation time and intraoperative conditions. Preoperative, 3, 12, 24 months of postoperative and at the last follow-up, the pain of back and leg of visual analog scale (VAS), Oswestry dysfunction index (ODI), and Japanese Orthopaedic Association Assessment Treatment Score (JOA) were performed, and the paired student's t test was used to the compare the continuous variables preoperatively and postoperatively. The clinical efficacy was evaluated according to MacNab standards. The lumbar MRI was performed to evaluate the decompression of the nerve roots, and the lumbar lateral and dynamic X-rays were performed to evaluate the stability of the surgical segment.
A total of 32 patients were included in the study, including 17 males and 15 females. The follow-up time ranged from 24 to 50 months, with an average of (33.2 ± 8.1) months and an average operation time of (62.7 ± 28.1) minutes. Compared to preoperatively, the VAS score of the back and leg pain (p < 0.05), ODI (p < 0.05), and JOA (p < 0.05) postoperatively were significantly improved. At the last follow-up, according to the modified MacNab standard assessment, 24 cases were excellent, five cases were good, and three cases were fair, the excellent and good rate was 90.65%. As for complications, one case had a small rupture of the dural sac during the operation, which was found but not repaired during the operation, and one case recurred after the operation. At the last follow-up, there were three cases of intervertebral instability.
PELD showed satisfactory short-term efficacy and safety in the management of ASD after lumbar fusion in elderly patients. Therefore, PELD might be an alternative choice for elderly patients with symptomatic ASD after lumbar fusion, but surgical indications must be strictly controlled.
治疗邻近节段疾病（ASD）仍存在争议。本研究旨在评估经皮全内镜腰椎间盘切除术（PELD）治疗老年腰椎融合术后 ASD 的短期疗效和安全性，并分析其技术优势、手术入路和适应证。
回顾性分析 2017 年 10 月至 2020 年 1 月收治的 32 例症状性 ASD 患者行 PELD 治疗的临床资料。所有患者均采用经椎间孔入路，记录手术时间和术中情况。术前、术后 3、12、24 个月及末次随访时，采用视觉模拟评分（VAS）评估腰痛和腿痛的程度，采用 Oswestry 功能障碍指数（ODI）和日本骨科协会评估治疗评分（JOA）评估功能，采用配对 t 检验比较术前和术后的连续变量。根据 MacNab 标准评价临床疗效。腰椎 MRI 评估神经根减压情况，腰椎侧位和动力位 X 线片评估手术节段稳定性。
共纳入 32 例患者，男 17 例，女 15 例。随访时间 24~50 个月，平均（33.2±8.1）个月，平均手术时间（62.7±28.1）min。与术前相比，术后腰痛和腿痛的 VAS 评分（p<0.05）、ODI（p<0.05）和 JOA（p<0.05）均明显改善。末次随访时，根据改良 MacNab 标准评估，优 24 例，良 5 例，可 3 例，优良率为 90.65%。并发症方面，术中发现 1 例硬脊膜小破裂，但未予修补，术后 1 例复发。末次随访时，3 例出现椎间隙不稳。
PELD 治疗老年腰椎融合术后 ASD 具有满意的短期疗效和安全性。因此，对于老年腰椎融合术后有症状 ASD 患者，PELD 可能是一种替代选择，但手术适应证必须严格控制。
