Sun Kai, Wang Hongyi, Zeng Ran, Cao Le
Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui province, China.
Department of Intensive Care Unit, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui province, China.
World Neurosurg. 2023 Oct;178:e520-e525. doi: 10.1016/j.wneu.2023.07.113. Epub 2023 Jul 27.
Percutaneous endoscopic interlaminar discectomy (PEID) has been widely used in minimally invasive treatment of lumbar disc herniation (LDH) but is difficult to perform because of the narrow interlaminar window and painful for the patient. Therefore, further research is needed to find a safe and effective method to facilitate the development of PEID.
Seventy-one consecutive patients with LDH who underwent PEID using a laminotomy technique with modified stepwise local anesthesia between July 2017 and June 2020. All patients were followed up for at least 6 months. Preoperative patient demographics, perioperative outcomes, and clinical outcomes were recorded. Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and Macnab criteria were used to assess clinical results.
All patients underwent successful surgery under local anesthesia with no conversions to open surgery. The mean operation time was 79.56 ± 32.78 minutes and the average hospital stay was 6.44 ± 2.98 nights. Before surgery, the mean VAS score was 5.66 ± 1.206 and the mean ODI score was 68.41 ± 6.634; the respective scores were decreased to 0.65 ± 0.635 and 7.06 ± 1.594 after 4 weeks of follow-up (P < 0.001) and to 0.56 ± 0.691 and 7.11 ± 0.176 after 6 months (P < 0.001). According to the MacNab criteria, the outcome was excellent in 60 cases and good in the remaining 11 cases.
PEID via a laminotomy technique with stepwise local anesthesia is safe and effective for L4-5 and L5-S1 LDH.
经皮内镜椎间孔切开椎间盘切除术（PEID）已广泛应用于腰椎间盘突出症（LDH）的微创治疗，但由于椎间孔窗口狭窄，手术操作困难，且患者疼痛明显。因此，需要进一步研究以找到一种安全有效的方法来促进PEID的发展。
2017年7月至2020年6月期间，连续71例接受LDH治疗的患者采用改良逐步局部麻醉的椎板切开技术进行PEID。所有患者均随访至少6个月。记录患者术前人口统计学资料、围手术期结果和临床结果。采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）评分和Macnab标准评估临床效果。
所有患者均在局部麻醉下成功完成手术，无一例转为开放手术。平均手术时间为79.56±32.78分钟，平均住院时间为6.44±2.98晚。术前，平均VAS评分为5.66±1.206，平均ODI评分为68.41±6.634；随访4周后，相应评分分别降至0.65±0.635和7.06±1.594（P<0.001），6个月后降至0.56±0.691和7.11±0.176（P<0.001）。根据MacNab标准，60例结果为优，其余11例为良。
采用逐步局部麻醉的椎板切开技术进行PEID治疗L4-5和L5-S1 LDH安全有效。
