Tang Q, Tang Z X, Shen M K, Wang Y P, Yang H J
Department of Mini-invasive Spinal Surgery, the Third People's Hospital of Henan Province, Zhengzhou 450000, China.
Zhonghua Wai Ke Za Zhi. 2025 Sep 1;63(9):814-820. doi: 10.3760/cma.j.cn112139-20241016-00463.
To explore the clinical efficacy and safety of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) techniques in treating recurrent lumbar disc herniation (RLDH). This study is a retrospective cohort study. The clinical data were retrospectively collected from 68 patients who underwent surgical treatment for RLDH at Department of Mini-invasive Spinal Surgery, the Third People's Hospital of Henan Province from June 2020 to June 2023. The patients were divided into the UBE group (38 cases) and the PTED group (30 cases) based on the surgical technique used. The drainage volume, surgery duration, and postoperative complications for revision surgeries in both groups were recorded. Visual analogue scale(VAS) and Oswestry disability index (ODI) were used to assess back pain and leg pain degrees and improvements preoperatively, 3 days postoperatively, 3 months postoperatively, and at the final follow-up. The modified Macnab criteria were used to evaluate outcomes at the final follow-up. The data comparison was conducted using independent sample -test, repeated measures analysis of variance, test or Fisher's exact test. All surgeries were successfully completed. The surgery duration in the UBE group was significantly shorter than in the PTED group, with statistically significant differences ((50.9±10.5)minutes (55.9±12.5)minutes,=1.234, =0.001). All patients were followed up for more than 1 year, with a follow-up period of (18.1±5.6) months (range: 12 to 29 months). Both groups showed a significant reduction in VAS and ODI for back and leg pain at all postoperative time points compared to preoperative scores (all <0.05). However, there were no statistically significant differences in VAS of low back pain, lower limb pain score and ODI score over time between the groups (all >0.05). At the final follow-up, the UBE group had an excellent and good rate of 92.1% (35/38); the PTED group had an excellent and good rate of 86.6% (26/30)(=0.727, =0.867). One patient in the UBE group and three in the PTED group experienced cerebrospinal fluid leaks, and one patient in the PTED group experienced postoperative leg numbness; all were discharged after conservative treatment. At the final follow-up, lumbar X-rays, CT, and MRI evaluations showed no recurrence or instability at the surgical segments. Both UBE and PTED can achieve good clinical outcomes in the treatment of RLDH through continuous visualization. The choice of surgical method for RLDH should be more precisely tailored to the individual.
探讨单侧双通道内镜（UBE）与经皮椎间孔镜椎间盘切除术（PTED）治疗复发性腰椎间盘突出症（RLDH）的临床疗效及安全性。本研究为回顾性队列研究。回顾性收集2020年6月至2023年6月在河南省第三人民医院微创脊柱外科接受RLDH手术治疗的68例患者的临床资料。根据所采用的手术技术将患者分为UBE组（38例）和PTED组（30例）。记录两组翻修手术的引流量、手术时间及术后并发症。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估术前、术后3天、术后3个月及末次随访时的腰背痛和腿痛程度及改善情况。采用改良Macnab标准评估末次随访时的疗效。采用独立样本t检验、重复测量方差分析、检验或Fisher确切概率法进行数据比较。所有手术均顺利完成。UBE组手术时间显著短于PTED组，差异有统计学意义（（50.9±10.5）分钟 比（55.9±12.5）分钟，t=1.234，P=0.001）。所有患者均随访1年以上，随访时间为（18.1±5.6）个月（范围：12至29个月）。与术前评分相比，两组术后各时间点腰背痛和腿痛的VAS及ODI均显著降低（均P<0.05）。然而，两组间腰背痛VAS、下肢疼痛评分及ODI评分随时间变化差异无统计学意义（均P>0.05）。末次随访时，UBE组优良率为92.1%（35/38）；PTED组优良率为86.6%（26/30）（χ²=0.727，P=0.867）。UBE组1例患者、PTED组3例患者出现脑脊液漏，PTED组1例患者术后出现下肢麻木；经保守治疗后均出院。末次随访时，腰椎X线、CT及MRI评估显示手术节段无复发或失稳。UBE和PTED通过持续可视化在RLDH治疗中均能取得良好的临床疗效。RLDH手术方法的选择应更精准地个体化。
