Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Institute of Orthopedics of Jiangxi Province, Nanchang, China.
Orthop Surg. 2024 May;16(5):1064-1072. doi: 10.1111/os.14031. Epub 2024 Mar 31.
Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID.
Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores.
The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported.
MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.
与传统的开放性手术相比，经皮内窥镜腰椎间盘切除术（PELD）具有创伤小、恢复快、术后疼痛少等优点，因此在脊柱外科领域得到了广泛应用。然而，它仍然存在术中透视发生、并发症甚至脊髓和神经损伤的风险。本研究旨在比较改良经皮内窥镜椎间孔入路椎间盘切除术（MPEID）与经皮内窥镜经椎间孔入路椎间盘切除术（PETD）治疗 L4/5 腰椎间盘突出症（LDH）的临床疗效，并评估 MPEID 的有效性和安全性。
回顾性研究 2020 年 6 月至 2021 年 6 月南昌大学第二附属医院收治的 34 例 L4/5 LDH 患者。其中 17 例行 MPEID，17 例行 PETD。分析的变量包括人口统计学、手术时间、术中透视次数和手术结果。采用视觉模拟评分（VAS）、Oswestry 残疾指数（ODI）和改良 MacNab 标准评估疗效。腰椎磁共振成像（MRI）用于评估影像学结果。采用配对 t 检验比较组内术前和术后的临床资料、VAS 和 ODI 评分。
PETD 组的平均手术时间为 91.65±14.04min，MPEID 组的平均手术时间为 65.41±12.61min（p<0.001）。在 PETD 组中，透视次数平均为 9.71±1.05 次，MPEID 组透视次数平均为 6.47±1.00 次（p<0.001）。12 个月随访时，两组临床疗效均显著改善。MPEID 组 VAS-背评分从 5.41±2.18 降至 1.76±1.09（p<0.001），VAS-腿评分从 6.53±1.66 降至 0.82±0.64（p<0.001）。ODI 评分从 51.35±10.65 降至 11.71±2.91（p<0.001）。在 PETD 组中，VAS-背评分从 4.94±1.98 降至 2.06±1.25（p<0.001），VAS-腿评分从 7.12±1.73 降至 1.12±0.60（p<0.001），ODI 评分从 48.00±11.62 降至 12.24±2.56（p<0.001）。根据改良 MacNab 标准，MPEID 组有 15 例为优秀，2 例为良好；PETD 组有 12 例为优秀，5 例为良好（p=0.23）。无神经根损伤、硬脊膜撕裂或明显并发症发生。
MPEID 和 PETD 均可有效治疗 L4/5 LDH，MPEID 手术时间更短，透视次数更少。此外，MPEID 组在短期内可提供与 PETD 组相当的优异临床疗效。
