Zhao Leyu, Yan Qi, Yuan Lijie, Wu Tianyi, Teng Yun, Niu Junjie, Song Dawei, Wang Jinning, Sun Xiao, Chen Rui, Zhong Xianggu, Li Jiarong, Gu Xiaolan, Zou Jun
Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Orthopaedic Surgery, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, China.
Front Pain Res (Lausanne). 2025 Mar 14;6:1568227. doi: 10.3389/fpain.2025.1568227. eCollection 2025.
Lumbar disc herniation (LDH) is a prevalent degenerative disc disorder frequently resulting in lumbar and leg pain. Obese patients with LDH often encounter the scenario where the disc herniation is not completely resolved in the short term following percutaneous transforaminal endoscopic discectomy (PTED), necessitating subsequent surgical intervention, or where long-term reherniation occurs post-procedure. Currently, the literature provides little information regarding the application of annulus fibrosus suture (AFS) as a supplementary measure to PTED for diminishing the recurrence of disc herniation. Our aim was to evaluate the short-term and long-term therapeutic outcomes of combining PTED with AFS, with a particular focus on the impact of AFS on the recurrence rate of disc herniation following PTED.
We recruited 23 obese patients with single-level LDH diagnosed between December 2021 and December 2023. All patients successfully underwent PTED in conjunction with AFS and the postoperative follow-up. We collected and analyzed data related to baseline parameters, disc degeneration grading, clinical effectiveness, surgery-related factors, lumbar spine function, pain severity, quality of life, and adverse prognosis events.
Compared with preoperative assessments, all patients exhibited significant improvements in Visual Analog Scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores ( < 0.05). During the short-term follow-up period, no patient required a secondary conventional microdiscectomy due to severe complications. At the one-year follow-up, no patient experienced significant recurrent radicular leg pain that would raise suspicion of LDH recurrence. However, when PTED was combined with AFS, the improvement in Visual Analog Scale for back pain (VAS-BP) was relatively less pronounced.
The synergy of PTED and AFS seems to be a comparatively safe and efficacious approach for treating LDH in obese patients. AFS reduces the incidence of long-term recurrent leg pain, which may in turn reduce the probability of LDH recurrence after PTED. Consequently, AFS should be regarded as an efficacious supplementary procedure to PTED, adept at efficiently reducing the recurrence rate in obese individuals with LDH.
腰椎间盘突出症（LDH）是一种常见的椎间盘退变疾病，常导致腰腿痛。肥胖的腰椎间盘突出症患者在经皮椎间孔镜下椎间盘切除术（PTED）后短期内，常常会出现椎间盘突出未完全缓解的情况，需要后续手术干预，或者术后出现长期复发。目前，关于应用纤维环缝合术（AFS）作为PTED的补充措施以减少椎间盘突出复发的相关文献报道较少。我们的目的是评估PTED联合AFS的短期和长期治疗效果，特别关注AFS对PTED后椎间盘突出复发率的影响。
我们招募了2021年12月至2023年12月期间诊断为单节段LDH的23例肥胖患者。所有患者均成功接受了PTED联合AFS及术后随访。我们收集并分析了与基线参数、椎间盘退变分级、临床疗效、手术相关因素、腰椎功能、疼痛严重程度、生活质量和不良预后事件相关的数据。
与术前评估相比，所有患者的腿痛视觉模拟量表（VAS-LP）、Oswestry功能障碍指数（ODI）和日本矫形外科学会（JOA）评分均有显著改善（<0.05）。在短期随访期间，没有患者因严重并发症需要二次传统显微椎间盘切除术。在一年的随访中，没有患者出现明显的复发性根性腿痛，提示LDH复发。然而，当PTED联合AFS时，背痛视觉模拟量表（VAS-BP）的改善相对不明显。
PTED与AFS联合似乎是治疗肥胖患者LDH的一种相对安全有效的方法。AFS降低了长期复发性腿痛的发生率，这反过来可能降低PTED后LDH复发的可能性。因此，AFS应被视为PTED的一种有效补充手术，能够有效降低肥胖LDH患者的复发率。
