Liu Sijia, Zhang Xianghong, Xiong Yang, He Hongchen
West China, Hospital Sichuan University, Chengdu, Sichuan, China.
Sichuan University, Chengdu, Sichuan, China.
Int J Surg. 2025 May 28. doi: 10.1097/JS9.0000000000002434.
Minimally invasive treatment plays a pivotal role in the management of lumbar disc herniation(LDH). Owing to its benefits, including reduced trauma, accelerated recovery, and decreased incidence of complications, it has progressively emerged as the primary approach for treating this condition. The objective of this study was to compare the outcomes observed in patients who underwent various minimally invasive surgical techniques for the treatment of lumbar disc herniation.
Systematic reviews and meta-analyses.
A systematic review was conducted to evaluate and compare the effectiveness of various minimally invasive treatment options for lumbar disc herniation, including percutaneous transforaminal endoscopic discectomy (PTED), microendoscopic discectomy (MED), microendoscopic discectomy (MD), percutaneous endoscopic interlaminar discectomy (PEID), endoscopic diskectomy (ED), full-endoscopic discectomy (FED), percutaneous endoscopic lumbar discectomy (PELD) and PELD combined with platelet-rich plasma (PRP). The outcomes assessed included visual analog scores (VAS) for leg pain and back pain, Japanese Orthopedic Association scores, the Oswestry Disability Index (ODI), 36 physical functioning and bodily pain scores, the EuroQol five-dimensional score, the numeric pain score (NRS), the duration of surgery, and the relative risk of reoperation. The collected data were analyzed via a random effects meta-analysis approach.
This review analyzed 22 comparative studies with 4,068 patients. Compared to MED, PTED had a shorter operative time (64.19 minutes vs. MED's 66.61 minutes; not significant), less intraoperative blood loss (16.97 vs. 28.55; P<0.001), and a shorter hospital stay (4.92 days vs. 6.71 days; P<0.001). MED was associated with a lower postoperative recurrence rate (3.69% vs. 6.08% for PTED). Compared with PTED, PEID was associated with lower ODI (12.69 vs. 15.39; P = 0.77) and VAS scores (1.38 vs. 1.46; P = 0.42). MD significantly decreased intraoperative blood loss (48.63 vs. 64.4 in the ED) and operative time (85.38 vs. 114.65). The combination of PELD and PRP injections provided pain relief and reduced recurrence.
Different minimally invasive surgeries for lumbar disc herniation have unique benefits. PTED has advantages in terms of operative time, blood loss, and length of hospital stay. However, there is a risk of nerve damage and cerebrospinal fluid leakage. The recurrence rate of MED is low. PEID is associated with lower ODI and VAS scores. MD reduces blood loss and operative time. The combination of PELD and PRP injections provides a new therapeutic direction for the treatment of lumbar disc herniation by relieving pain, reducing recurrence, improving patient satisfaction and possibly promoting disc repair.
微创治疗在腰椎间盘突出症（LDH）的管理中起着关键作用。由于其具有减少创伤、加速康复和降低并发症发生率等益处，它已逐渐成为治疗该病症的主要方法。本研究的目的是比较接受各种微创外科技术治疗腰椎间盘突出症的患者的观察结果。
系统评价和荟萃分析。
进行了一项系统评价，以评估和比较各种微创治疗腰椎间盘突出症方法的有效性，包括经皮椎间孔镜下椎间盘切除术（PTED）、显微内镜下椎间盘切除术（MED）、显微内镜下椎间盘切除术（MD）、经皮内镜下椎板间椎间盘切除术（PEID）、内镜下椎间盘切除术（ED）、全内镜下椎间盘切除术（FED）、经皮内镜下腰椎间盘切除术（PELD）以及PELD联合富血小板血浆（PRP）。评估的结果包括腿痛和背痛的视觉模拟评分（VAS）、日本骨科协会评分、Oswestry功能障碍指数（ODI）、36项身体功能和身体疼痛评分、欧洲五维健康量表评分、数字疼痛评分（NRS）、手术时长以及再次手术的相对风险。通过随机效应荟萃分析方法对收集的数据进行分析。
本综述分析了22项比较研究，涉及4068例患者。与MED相比，PTED的手术时间较短（64.19分钟对MED的66.61分钟；无显著差异），术中失血量较少（16.97对28.55；P<0.001），住院时间较短（4.92天对6.71天；P<0.001）。MED的术后复发率较低（3.69%对PTED的6.08%）。与PTED相比，PEID的ODI较低（12.69对15.39；P = 0.77）且VAS评分较低（1.38对1.46；P = 0.42）。MD显著减少了术中失血量（48.63对ED的64.4）和手术时间（85.38对114.65）。PELD与PRP注射联合使用可缓解疼痛并降低复发率。
不同的腰椎间盘突出症微创手术有其独特的益处。PTED在手术时间、失血量和住院时间方面具有优势。然而，存在神经损伤和脑脊液漏的风险。MED的复发率较低。PEID与较低的ODI和VAS评分相关。MD减少了失血量和手术时间。PELD与PRP注射联合使用通过缓解疼痛、降低复发率、提高患者满意度并可能促进椎间盘修复，为腰椎间盘突出症的治疗提供了新的治疗方向。
