Du Chuanchao, Song Kunfeng, Hai Bao, Wang Xiangyu
Orthopedic Surgery, Emergency General Hospital/National Emergency Medicine Research Center, Beijing, CHN.
Center of Minimal Invasive Spine Surgery, Henan People's Third Hospital, Zhengzhou, CHN.
Cureus. 2023 Dec 23;15(12):e50993. doi: 10.7759/cureus.50993. eCollection 2023 Dec.
Objective The objective of this study was to investigate the long-term effects of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) and clarify the differences between outside-in and inside-out techniques. Methodology This was a multicenter retrospective study with a chart review of questionnaires about patients' quality of life. Patients were recruited from three hospitals in China. Based on certain inclusion and exclusion criteria, we enrolled in the study 5000 patients aged ≥18 years diagnosed with lumbar disc herniation who received PTELD from September 2015 to September 2019. The outside-in technique (n=2039) was compared with the inside-out technique for PTELD (n=1890) on the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the Short Form 36 (SF-36) of the Health Survey Questionnaire (physical component) both pre-operatively and post-operatively. Results VAS, ODI, and SF-36 significantly improved just after surgery for both techniques compared with pre-operative status. Nevertheless, significant differences existed between the two techniques concerning VAS for leg pain, VAS for back pain, ODI, and SF-36 at 0.5 months post-operatively. The above indices steadily improved within six months after both techniques, after which they did not significantly improve. In detail, outside-in patients suffered more back pain and worse ODI and SF-36 (physical) but had more relief from leg pain 0.5 months after surgery in terms of VAS. As for recovery rate from symptoms, there were only significant differences in recovery rate for leg pain and back pain at the first 1.5 months post-operatively. As for satisfaction rates, the outside-in technique had better results than the inside-out technique at both 0.5 months and 12 months. Conclusion Both techniques could relieve the symptoms of lumbar disc herniation. However, patients in the outside-in group suffered more back pain and a bigger risk of nerve injury than those in the inside-out group.
目的 本研究旨在探讨经皮椎间孔镜下腰椎间盘切除术（PTELD）的长期疗效，并阐明由外向内技术与由内向外技术之间的差异。方法 这是一项多中心回顾性研究，通过查阅病历对患者生活质量问卷进行分析。患者来自中国的三家医院。根据特定的纳入和排除标准，我们纳入了2015年9月至2019年9月期间接受PTELD治疗的5000例年龄≥18岁、诊断为腰椎间盘突出症的患者。在术前和术后，对采用由外向内技术（n=2039）和由内向外技术（n=1890）进行PTELD的患者，依据视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）以及健康调查简表36（SF-36）的身体成分部分进行比较。结果 与术前状态相比，两种技术术后VAS、ODI和SF-36均显著改善。然而，术后0.5个月时，两种技术在腿痛VAS、背痛VAS、ODI和SF-36方面存在显著差异。两种技术术后6个月内上述指标均稳步改善，此后无显著改善。具体而言，由外向内技术组患者术后背痛更严重，ODI和SF-36（身体成分）更差，但术后0.5个月时腿痛缓解程度在VAS方面更明显。至于症状缓解率，术后前1.5个月仅在腿痛和背痛缓解率方面存在显著差异。至于满意率，在术后0.5个月和12个月时，由外向内技术组的结果均优于由内向外技术组。结论 两种技术均可缓解腰椎间盘突出症的症状。然而，由外向内技术组患者比由内向外技术组患者背痛更严重，神经损伤风险更大。
