Andersen Gustav Østerheden, Milosevic Stefan, Jensen Mads Moss, Carreon Leah, Pedersen Casper Friis, Andersen Mikkel Østerheden, Helmig Peter
Department of Clinical Medicine-Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Department of Clinical Medicine-Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
World Neurosurg. 2025 Mar;195:123641. doi: 10.1016/j.wneu.2024.123641. Epub 2025 Feb 7.
To investigate patient-reported outcomes following lumbar discectomy in patients with lateral lumbar disc herniation (LDH) compared with patients with paramedian LDH.
Data on patients with lateral and paramedian LDH operated on between 2017 and 2020 at a single public spine unit were extracted from the National Danish Spine Registry, DaneSpine. A propensity score-matched, case-control analysis was conducted to compare the 2 groups. Subgroup analysis was done by further dividing the lateral LDH group into foraminal and extraforaminal groups. Patient demographics, Oswestry Disability Index visual analog scale (VAS) leg and back pain (0-100), EuroQol-5D questionnaire, and measures of patient improvement and satisfaction were collected at baseline and 1 year postoperatively.
Of 887 eligible patients, baseline and 1-year follow-up data were available for 525 patients with paramedian LDH and 68 patients with lateral LDH. Following propensity score matching, the 2 groups were similar in terms of all baseline characteristics (P > 0.05). There were no significant differences between groups in Oswestry Disability Index, VAS leg pain, VAS back pain, and EuroQol-5D 1 year postoperatively. Both groups improved in all outcomes from inclusion to follow-up (P < 0.001). Subgroup analysis showed that patients with foraminal LDH compared with extraforaminal LDH had a significantly greater improvement in VAS leg pain (P = 0.016) with a larger number of patients with clinically significant leg pain improvement (P = 0.03).
Patients with lateral and paramedian LDH reported similar postsurgical outcomes. Spine surgeons should be less hesitant to operate on patients with lateral LDH. Patients with extraforaminal LDH experienced the least relief of leg pain.
比较外侧腰椎间盘突出症（LDH）患者与旁正中LDH患者行腰椎间盘切除术后的患者报告结局。
从丹麦国家脊柱注册中心DaneSpine提取2017年至2020年在单一公立脊柱科室接受手术的外侧和旁正中LDH患者的数据。进行倾向评分匹配的病例对照分析以比较两组。通过将外侧LDH组进一步分为椎间孔型和椎间孔外型组进行亚组分析。在基线和术后1年收集患者人口统计学资料、Oswestry功能障碍指数视觉模拟量表（VAS）腿部和背部疼痛评分（0 - 100）、欧洲五维健康量表问卷以及患者改善和满意度指标。
在887例符合条件的患者中，525例旁正中LDH患者和68例外侧LDH患者有基线和1年随访数据。倾向评分匹配后，两组在所有基线特征方面相似（P > 0.05）。术后1年，两组在Oswestry功能障碍指数、VAS腿部疼痛、VAS背部疼痛和欧洲五维健康量表方面无显著差异。从纳入到随访，两组在所有结局指标上均有改善（P < 0.001）。亚组分析显示，与椎间孔外型LDH患者相比，椎间孔型LDH患者的VAS腿部疼痛改善更显著（P = 0.016），且有更多患者的腿部疼痛有临床显著改善（P = 0.03）。
外侧和旁正中LDH患者报告的术后结局相似。脊柱外科医生在为外侧LDH患者手术时应减少顾虑。椎间孔外型LDH患者的腿部疼痛缓解最少。
