Liang Xiao, Ran Lijing, Zhai Ning, Huang Longao, Wang Congyang, Jiang Hua
Department of Spine Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China; Department of Spine Surgery, Affiliated Hospital of Jining Medical University, Jining, China.
Department of Ultrasound, Affiliated Hospital of Jining Medical University, Jining, China.
World Neurosurg. 2025 Mar;195:123647. doi: 10.1016/j.wneu.2024.123647. Epub 2025 Jan 28.
A sufficient foraminoplasty is critical in percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH), which may affect the progress of surgery. This study assessed repeated foraminoplasty (RF) applied in PETD for patients with LDH and lumbar foraminal stenosis.
This study enrolled 133 patients with LDH and lumbar foraminal stenosis who underwent PETD; patients were assigned to traditional foraminoplasty (TF) and RF groups. Intervertebral foramen enlargement and ratio of nerve roots completely exposed were compared between the 2 groups. Perioperative indicators were assessed for surgical efficiency and safety. Visual analog scale score, Oswestry Disability Index score, and MacNab criteria were used to evaluate clinical outcomes.
Anterior-posterior diameter increase of intervertebral foramen (P < 0.001) and ratio of the nerve roots completely exposed (P = 0.032) in the RF group were significantly greater than those in the TF group. The decompression time and total operative time of the patients who underwent RF were significantly shorter compared with patients who underwent TF (P < 0.001). With respect to evaluation of clinical efficacy, the visual analog scale score of leg pain in the TF group was greater than that in the RF group only on the first day postoperatively (P = 0.031).
Repeated foraminoplasty applied in PETD for patients with LDH and lumbar foraminal stenosis might improve intervertebral foramen enlargement in anterior-posterior diameter, exposure of nerve roots, surgical efficiency, and immediate relief of leg pain after surgery.
在经皮内镜下经椎间孔椎间盘切除术（PETD）治疗腰椎间盘突出症（LDH）时，充分的椎间孔成形术至关重要，其可能会影响手术进程。本研究评估了重复椎间孔成形术（RF）在PETD治疗LDH合并腰椎椎间孔狭窄患者中的应用。
本研究纳入了133例行PETD治疗的LDH合并腰椎椎间孔狭窄患者；将患者分为传统椎间孔成形术（TF）组和RF组。比较两组间椎间孔扩大情况及神经根完全暴露的比例。评估围手术期指标以衡量手术效率和安全性。采用视觉模拟量表评分、Oswestry功能障碍指数评分和MacNab标准来评估临床疗效。
RF组椎间孔前后径增加（P < 0.001）及神经根完全暴露比例（P = 0.032）均显著大于TF组。与接受TF的患者相比，接受RF的患者减压时间和总手术时间显著缩短（P < 0.001）。在临床疗效评估方面，仅在术后第1天TF组腿痛的视觉模拟量表评分高于RF组（P = 0.031）。
重复椎间孔成形术应用于PETD治疗LDH合并腰椎椎间孔狭窄患者，可能会改善椎间孔前后径扩大、神经根暴露、手术效率以及术后腿部疼痛的即刻缓解情况。
