Ahn Yong
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea.
J Clin Med. 2025 May 18;14(10):3529. doi: 10.3390/jcm14103529.
: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive and popular surgical method for the treatment of lumbar disc herniation. Although TELD offers favourable outcomes and enables fast recovery, some patients experience rebound pain and transient postoperative pain, which can delay rehabilitation and decrease patient satisfaction. : This narrative review was conducted based on a comprehensive literature search of the MEDLINE database, supplemented by the author's clinical experience. Relevant articles were identified using the keywords "rebound pain" and "transforaminal endoscopic lumbar discectomy" or "percutaneous endoscopic lumbar discectomy". A thorough examination of rebound pain after TELD was performed by reviewing what has currently been published about its clinical traits. It was also compared with what could be observed in open lumbar discectomy and proposed preventive measures. : Rebound pain typically occurs within 2 weeks postoperatively and resolves spontaneously within 3 weeks. The proposed pathologies include inflammatory edema, transient ischemia, neural hypersensitivity, and increased pressure inside the disc. Risk factors include early unreasonable activity, incomplete release, and psychological predispositions. Rebound pain must be distinguished from recurrent herniation. Prevention strategies include adequate decompression, minimal neural irritation, postoperative medications, and early mobilization protocols. : Rebound pain after TELD is self-limiting but has a clinical effect that may delay timely rehabilitation and raise concerns for surgeons and patients. Awareness and early recognition can enhance postoperative care and optimize clinical outcomes after TELD.
经椎间孔内镜下腰椎间盘切除术(TELD)是治疗腰椎间盘突出症的一种微创且常用的手术方法。尽管TELD能带来良好的治疗效果并促使患者快速康复,但一些患者会经历反弹痛和术后短暂疼痛,这可能会延迟康复进程并降低患者满意度。
本叙述性综述基于对MEDLINE数据库的全面文献检索,并结合作者的临床经验进行。使用关键词“反弹痛”和“经椎间孔内镜下腰椎间盘切除术”或“经皮内镜下腰椎间盘切除术”来识别相关文章。通过回顾目前已发表的关于TELD后反弹痛的临床特征,对其进行了全面检查。还将其与开放性腰椎间盘切除术中观察到的情况进行了比较,并提出了预防措施。
反弹痛通常在术后2周内出现,并在3周内自行缓解。推测的病理机制包括炎症性水肿、短暂性缺血、神经超敏反应以及椎间盘内压力增加。风险因素包括早期不合理活动、减压不彻底以及心理因素。反弹痛必须与复发性椎间盘突出相鉴别。预防策略包括充分减压、尽量减少神经刺激、术后药物治疗以及早期活动方案。
TELD后的反弹痛具有自限性,但其临床影响可能会延迟及时康复,并引起外科医生和患者的担忧。提高认识和早期识别可以加强术后护理,并优化TELD后的临床效果。