Pruttikul Pritsanai, Pluemvitayaporn Tinnakorn, Bannachirakul Mana, Surapuchong Suttinont, Kittithamvongs Piyabuth, Ratanakoosakul Warot, Tiracharnvut Kitjapat, Piyasakulkaew Chaiwat, Kunakornsawat Sombat
Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Research Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Asian J Neurosurg. 2025 Mar 10;20(2):337-343. doi: 10.1055/s-0045-1805018. eCollection 2025 Jun.
Retrospective cohort study.
Foraminal and extraforaminal disc herniations account for 7 to 12% of lumbar herniated discs. Various surgical methods, including midline approaches with facetectomy and paramedian techniques, involve significant bone removal, risking spinal instability. The percutaneous transforaminal approach for endoscopic access to lateral disc herniations presents several advantages over traditional techniques and may be more suitable for these cases.
This article evaluates the clinical outcomes and potential complications associated with the treatment of foraminal and extraforaminal lumbar disc herniations at the L3/4 and L4/5 levels in patients who have undergone transforaminal percutaneous endoscopic lumbar discectomy.
Between 2016 and 2020, a total of 32 patients diagnosed with single-level lumbar disc herniation at the L3/4 or L4/5 foraminal or extraforaminal levels, who had not responded to conservative management, underwent transforaminal endoscopic discectomy. Follow-up evaluations were performed on postoperative day 1 and at 2 weeks, 6 weeks, 3 months, and 12 months. Both pre- and postoperative assessments employed the visual analog scale (VAS) and the Oswestry Disability Index (ODI) to quantify pain levels and functional outcomes. Clinical outcomes were assessed according to the MacNab criteria to determine the efficacy of the surgical intervention.
The average age of patients was 52.6 years, with L4/5 (81.3%) and L3/4 (18.7%) being the most affected levels. The median follow-up was 18.2 months (range, 1-44 months). There was a significant reduction in VAS and ODI scores at follow-ups compared to preoperative levels ( < 0.01). All patients with preoperative neurological deficits improved, though six patients (18.7%) experienced transient dysesthesia that resolved in 6 weeks. Per the MacNab criteria, clinical efficacy was excellent in 56.3% of patients, good in 37.5%, and fair in 6.2%.
Transforaminal endoscopic lumbar discectomy is a safe and effective minimally invasive procedure for foraminal and extraforaminal lumbar disc herniations at the L3/4 and L4/5 levels. It preserves spinal stability, minimizes blood loss, reduces postoperative pain, and allows for quicker recovery, presenting a strong alternative for patients needing surgery for these conditions.
回顾性队列研究。
椎间孔型和椎间孔外型椎间盘突出症占腰椎间盘突出症的7%至12%。各种手术方法，包括行椎板切除术的中线入路和旁正中技术，都需要大量的骨质切除，存在脊柱不稳定的风险。经皮椎间孔入路内镜治疗外侧椎间盘突出症比传统技术具有多个优势，可能更适合这些病例。
本文评估经椎间孔入路经皮内镜下腰椎间盘切除术治疗L3/4和L4/5节段椎间孔型和椎间孔外型腰椎间盘突出症患者的临床疗效及潜在并发症。
2016年至2020年期间，共有32例被诊断为L3/4或L4/5节段椎间孔型或椎间孔外型单节段腰椎间盘突出症且保守治疗无效的患者接受了经椎间孔内镜下椎间盘切除术。在术后第1天、2周、6周、3个月和12个月进行随访评估。术前和术后评估均采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）来量化疼痛程度和功能结果。根据MacNab标准评估临床疗效，以确定手术干预的效果。
患者的平均年龄为52.6岁，最常受累的节段是L4/5（81.3%）和L3/4（18.7%）。中位随访时间为18.2个月（范围1至44个月）。与术前水平相比，随访时VAS和ODI评分显著降低（P < 0.01）。所有术前有神经功能缺损的患者均有改善，不过有6例患者（18.7%）出现短暂感觉异常，在6周内缓解。根据MacNab标准，56.3%的患者临床疗效优秀，37.5%为良好，6.2%为一般。
经椎间孔入路内镜下腰椎间盘切除术是治疗L3/4和L4/5节段椎间孔型和椎间孔外型腰椎间盘突出症的一种安全有效的微创手术。它能保持脊柱稳定性，减少失血量，减轻术后疼痛，并能更快恢复，为需要手术治疗这些病症的患者提供了一种有力的选择。
