Seddighi Amir Saied, Seddighi Afsoun, Hosseini Seyedmorteza
Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
World Neurosurg. 2025 Feb;194:123392. doi: 10.1016/j.wneu.2024.10.121. Epub 2024 Nov 22.
This study aims to compare the clinical outcomes of percutaneous laser disc decompression (PLDD) and open surgery for patients with radicular sciatic pain caused by lumbar disc herniation over a 2-year follow-up period.
In a prospective randomized controlled trial, 84 patients with chronic radicular pain were assigned to either the open surgery group (n = 42) or the PLDD group (n = 42). Patients were evaluated at baseline, and at 4, 8, 24, 48, and 96 weeks postintervention. Outcome measures included the Roland-Morris Disability Questionnaire, Visual Analog Scale for leg and back pain, and the Short Form-36 bodily pain and physical functioning subscales. Resurgery rates were also recorded.
No significant differences in Roland-Morris Disability Questionnaire, Visual Analog Scale for leg and back pain, or Short Form-36 scores were observed between the 2 groups at any follow-up time points. Both groups showed improvement in disability and pain scores over time, with similar patterns of recovery. The median resurgery rates were 19.0% for open surgery and 31.0% for PLDD (P = 0.314), indicating comparable long-term effectiveness of both treatments.
This study demonstrates that PLDD and open surgery provide similar long-term outcomes in terms of disability, pain relief, and physical functioning for patients with radicular sciatic pain. While PLDD is associated with a higher resurgery rate, it remains a viable minimally invasive alternative to open surgery. Further research is warranted to refine patient selection criteria and improve procedural efficacy for both interventions.
本研究旨在比较经皮激光椎间盘减压术（PLDD）和开放手术治疗腰椎间盘突出症所致坐骨神经痛患者的临床结局，随访期为2年。
在一项前瞻性随机对照试验中，84例慢性神经根性疼痛患者被分为开放手术组（n = 42）和PLDD组（n = 42）。在基线、干预后4周、8周、24周、48周和96周对患者进行评估。结局指标包括罗兰-莫里斯功能障碍问卷、腿部和背部疼痛视觉模拟量表以及简明健康状况调查36项身体疼痛和生理功能分量表。还记录了再次手术率。
在任何随访时间点，两组在罗兰-莫里斯功能障碍问卷、腿部和背部疼痛视觉模拟量表或简明健康状况调查36项评分方面均未观察到显著差异。两组的功能障碍和疼痛评分均随时间改善，恢复模式相似。开放手术的中位再次手术率为19.0%，PLDD为31.0%（P = 0.314），表明两种治疗方法的长期疗效相当。
本研究表明，对于坐骨神经痛患者，PLDD和开放手术在功能障碍、疼痛缓解和生理功能方面提供了相似的长期结局。虽然PLDD的再次手术率较高，但它仍然是一种可行的开放手术微创替代方案。有必要进一步研究以完善患者选择标准并提高两种干预措施的手术疗效。
