Kong Meng, Gao Changtong, Hao Meng, Ma Xuexiao, Zhao Jindong, Luan Jian, Lin Yong, Jin Canghai, Li Qiang
Department of Spine Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China.
Department of Oncology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China.
J Pain Res. 2025 Apr 16;18:2069-2080. doi: 10.2147/JPR.S498090. eCollection 2025.
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical (MIS) procedure rapidly improved in the surgical treatment of lumbar disc herniation (LDH). For the treatment of extraforaminal lumbar disc herniations (ELDH), microendoscopic discectomy (MED) or traditional Transforaminal Lumbar Interbody Fusion (MIS-TLIF) are commonly used, but limitations exist due to bony resection. Many classic surgical approaches for PELD have inherent disadvantage when removing migrated ELDH.
We aimed to present the results of a series of PELD cases that were operated using a modified endoscopic backhand holding (EBH) approach for the treatment of ELDH.
Seventy-two patients diagnosed with ELDH who underwent PELD via the EBH approach from January 2018 to December 2022 were retrospectively assessed. Pre- and postoperative clinical data, radiographic findings, and surgical techniques were investigated. Neurological recovery examinations were performed preoperatively and at 3 days, 1 month, 3 months, 6 months, 1 year postoperatively.
No major intraoperative complications were noted. Significant improvement in back and leg pain was observed in visual analogue scale (VAS) score, and the mean ODI was decreased from preoperative 78% (range = 60-98%) to postoperative 30% (20-40%) ( < 0.001) at 1-month follow-up and obtained further improvement at 1 year (mean ODI = 11%; range = 2-20%). All patients showed progressive improvement in their initial neurological deficits, with complete recovery of motor weakness. According to the Macnab criteria, overall excellent and good outcomes were obtained in 67 patients (95.7%) - 57 excellent (81.4%), and 10 (14.3%) good - with fair outcomes in three patients (4.3%) at the time of last follow-up.
Percutaneous endoscopic backhand holding is a minimally invasive, safe, valuable, and efficacious surgical procedure for treating ELDH. It is important that surgeons perform PELD using the technique they know best to ensure successful implementation of the surgery.
经皮内镜下腰椎间盘切除术（PELD）是一种在腰椎间盘突出症（LDH）手术治疗中迅速发展的微创手术（MIS）。对于椎间孔外型腰椎间盘突出症（ELDH）的治疗，通常采用显微内镜下椎间盘切除术（MED）或传统经椎间孔腰椎椎体间融合术（MIS-TLIF），但由于需要进行骨质切除，存在一定局限性。许多经典的PELD手术方法在处理移位型ELDH时存在固有缺点。
我们旨在展示一系列采用改良内镜反手握持（EBH）方法进行手术治疗ELDH的PELD病例结果。
回顾性评估了2018年1月至2022年12月期间72例经EBH方法行PELD治疗的ELDH患者。调查术前和术后的临床数据、影像学表现及手术技术。术前及术后3天、1个月、3个月、6个月、1年进行神经功能恢复检查。
术中未发现重大并发症。视觉模拟量表（VAS）评分显示腰腿痛明显改善，1个月随访时平均腰椎功能障碍指数（ODI）从术前的78%（范围=60%-98%）降至术后的30%（20%-40%）（<0.001），1年时进一步改善（平均ODI=11%；范围=2%-20%）。所有患者最初的神经功能缺损均有逐步改善，运动无力完全恢复。根据Macnab标准，末次随访时67例患者（95.7%）获得总体优良结果——57例优（81.4%），10例良（14.3%），3例患者（4.3%）结果一般。
经皮内镜反手握持术是一种治疗ELDH的微创、安全、有价值且有效的手术方法。外科医生采用他们最熟悉的技术进行PELD对于确保手术成功实施很重要。
