全内镜可视化椎间孔成形术和椎间盘切除术治疗双侧神经根病变腰椎间盘突出症的临床疗效。

Clinical Outcomes of Full-Endoscopic Visualized Foraminoplasty and Discectomy for Lumbar Disc Herniation with Bilateral Radiculopathy.

机构信息

Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.

Department of Orthopedic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China.

出版信息

Orthop Surg. 2024 Dec;16(12):3014-3025. doi: 10.1111/os.14240. Epub 2024 Oct 1.

DOI:10.1111/os.14240

PMID:39351639

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11608791/

Abstract

OBJECTIVE

The treatment of lumbar disc herniation (LDH) with bilateral radiculopathy using transforaminal endoscopic lumbar discectomy (TELD) remains challenging, especially at the L5/S1 level with narrow foramen or high iliac crest. Full-endoscopic visualized foraminoplasty and discectomy (FEVFD) is a newly developed technique for LDH and lumbar stenosis. However, there is limited evidence on the efficacy of FEVFD technique in the treatment of LDH with bilateral radiculopathy. This study was to assess the clinical outcomes and safety of using FEVFD in the treatment of LDH with bilateral radiculopathy.

METHODS

This retrospective study enrolled 63 patients with LDH presenting with bilateral radiculopathy between January 2018 and January 2022. Patients enrolled before January 2020 were treated using a conventional transforaminal endoscopic surgical system (TESSYS) technique (TESSYS, n = 33) and treated using a FEVFD technique after that (FEVFD, n = 30). The total operation time and the number of intraoperative fluoroscopies were recorded. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were evaluated preoperatively and postoperatively (at 1-month, 3-month, 6-month, and final follow-ups). Global outcomes at final follow-up were assessed using modified MacNab criteria.

RESULTS

Compared with TESSYS, patients in FEVFD group had a shorter operation time (92.9 vs. 78.0 min). The intraoperative fluoroscopies in FEVFD group were significantly lower than those in TESSYS group (18.7 vs. 4.9). After the operation, the VAS and ODI scores at all follow-ups in the two groups were significantly lower than those before operation. For the L5/S1 level, the values of VAS and ODI scores in FEVFD group were significantly lower than those of in TESSYS group at 3-month, 6-month, and final follow-up. For the L4/5 level, however, no significant difference was found in VAS and ODI scores between these two groups at the follow-ups. According to the modified MacNab criteria, the excellent-to-good rate in TESSYS and FEVFD groups was 84.8% and 90.0%, respectively.

CONCLUSION

For LDH with bilateral radiculopathy, using the FEVFD technique could not only reduce the operation time and radiation, but also improve the clinical outcomes at the L5/S1 level.

摘要

目的

对于双侧神经根病变的腰椎间盘突出症（LDH）的治疗，采用经椎间孔内窥镜腰椎间盘切除术（TELD）仍然具有挑战性，尤其是在椎间孔狭窄或髂嵴较高的 L5/S1 水平。全内镜下可视椎间孔成形术和椎间盘切除术（FEVFD）是一种新开发的用于治疗腰椎间盘突出症和腰椎狭窄症的技术。然而，关于 FEVFD 技术治疗双侧神经根病变的疗效的证据有限。本研究旨在评估 FEVFD 在治疗双侧神经根病变的 LDH 中的临床效果和安全性。

方法

这是一项回顾性研究，共纳入了 2018 年 1 月至 2022 年 1 月期间双侧神经根病变的 63 例 LDH 患者。2020 年 1 月之前接受治疗的患者采用传统经椎间孔内窥镜手术系统（TESSYS）技术（TESSYS，n=33），之后采用 FEVFD 技术（FEVFD，n=30）。记录总的手术时间和术中透视次数。术前和术后（术后 1 个月、3 个月、6 个月和最终随访）采用 Oswestry 残疾指数（ODI）和视觉模拟评分（VAS）进行评估。最终随访时采用改良 MacNab 标准评估整体疗效。

结果

与 TESSYS 相比，FEVFD 组的手术时间更短（92.9 分钟 vs. 78.0 分钟）。FEVFD 组的术中透视次数明显低于 TESSYS 组（18.7 次 vs. 4.9 次）。术后，两组在所有随访时间的 VAS 和 ODI 评分均明显低于术前。对于 L5/S1 水平，FEVFD 组在术后 3 个月、6 个月和最终随访时的 VAS 和 ODI 评分明显低于 TESSYS 组。然而，对于 L4/5 水平，两组在随访时的 VAS 和 ODI 评分无显著差异。根据改良 MacNab 标准，TESSYS 和 FEVFD 组的优良率分别为 84.8%和 90.0%。