Lee Chien-Ching, Lin Ruey-Mo, Juan Wei-Sheng, Chuang Hao-Yu, Lin Hung-Lin, Cheng Cheng-Hsin, Yao Chun-Hsu
Department of Anesthesia, An Nan Hospital, China Medical University, Tainan 70965, Taiwan.
Department of Medical Sciences Industry, Chang Jung Christian University, Tainan 71101, Taiwan.
J Clin Med. 2025 Mar 13;14(6):1925. doi: 10.3390/jcm14061925.
: The treatment for lumbar disc herniation (LDH) is surgical discectomy. This surgery may enhance spinal instability and exacerbate disc degeneration. The most common treatment options include microdiscectomy (MD), interspinous process device (IPD) implantation, and percutaneous endoscopic lumbar discectomy (PELD). As few studies have compared these three procedures, this study focused on collecting data on the clinical, functional, and imaging outcomes of surgery for symptomatic LDH. : This is a retrospective, transverse, and analytical study, with a total of 383 patients who received operations for symptomatic LDH between 2018 and 2022. Medical information from the charts of these patients was collected. The results were followed up on for a minimum of one year by collecting responses from several questionnaires and clinical data, including patients' scores on the visual analogue scale (VAS), Oswestry Disability Index (ODI), and symptomatic improvement score (SIS), as well as wound size, blood loss, hospital stay, postoperative disc change, and complications. : At the end of data collection, the VAS and ODI scores all showed significant improvement following these three procedures ( < 0.01). The SISs were all ranked as good (8.1, 8.5, and 7.9) post-surgery. PELD was a minimally invasive procedure that resulted in the smallest wound size (0.82 cm), minimal blood loss (21 mL), and a short hospital stay (4.2 days). A substantial pre-/postoperative change in disc height was noted in the MD (-17%) and PELD (-15%) groups. The complication rates were similar among the three groups (3%, 5%, and 5.6%). : IPD implantation and PELD yielded outcomes comparable to those of conventional MD for symptomatic relief and functional recovery. Although the complication rates were similar, the postoperative complications were quite different from those of the other procedures. PELD resulted in rapid recovery and minimal invasion, and IPD implantation showed a good ability to preserve disc height and spinal stability; however, the clinical relevance of these findings in disc degeneration remains controversial.
腰椎间盘突出症（LDH）的治疗方法是手术椎间盘切除术。这种手术可能会增强脊柱不稳定并加剧椎间盘退变。最常见的治疗选择包括显微椎间盘切除术（MD）、棘突间装置（IPD）植入术和经皮内镜下腰椎间盘切除术（PELD）。由于很少有研究比较这三种手术，本研究专注于收集有症状LDH手术的临床、功能和影像学结果的数据。
这是一项回顾性、横向和分析性研究，共有383例在2018年至2022年间接受有症状LDH手术的患者。收集了这些患者病历中的医疗信息。通过收集几份问卷的回复和临床数据，包括患者的视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）和症状改善评分（SIS），以及伤口大小、失血量、住院时间、术后椎间盘变化和并发症，对结果进行了至少一年的随访。
在数据收集结束时，这三种手术后VAS和ODI评分均显示出显著改善（<0.01）。术后SIS均被评为良好（8.1、8.5和7.9）。PELD是一种微创手术，伤口最小（0.82 cm），失血量最少（21 mL），住院时间短（4.2天）。MD组（-17%）和PELD组（-15%）的椎间盘高度术前/术后有显著变化。三组的并发症发生率相似（3%、5%和5.6%）。
IPD植入术和PELD在症状缓解和功能恢复方面的结果与传统MD相当。虽然并发症发生率相似，但术后并发症与其他手术有很大不同。PELD恢复快且侵袭性小，IPD植入术显示出良好的保持椎间盘高度和脊柱稳定性的能力；然而，这些发现在椎间盘退变中的临床相关性仍存在争议。
