Zheng Shicheng, Zhao Qinghua, Hu Zongshan, Li Haibo, Wang Bin, Zhu Zezhang, Qiu Yong, Sun Xu
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
J Pain Res. 2025 Aug 1;18:3821-3832. doi: 10.2147/JPR.S537181. eCollection 2025.
Highly migrated lumbar disc herniation (HM-LDH) presents a significant challenge for surgeons. This study aimed to assess the safety and clinical outcomes of large-channel interlaminar endoscopic discectomy for HM-LDH and compare it to open fenestration discectomy.
Patients who underwent large-channel interlaminar endoscopic discectomy (group A) or open fenestration discectomy (group B) for HM-LDH between January 2021 and December 2023 were included. Radiological and clinical outcomes were evaluated over at least one year. Operation time, intraoperative blood loss, postoperative drainage, postoperative hospital stay, patient-reported outcomes and complications were compared between groups, independent sample -tests and Fisher's exact probability test were performed for two groups.
One hundred and thirty-six patients were retrospectively included in this study, with 84 in group A and 52 in group B, respectively. Although similar operative time was observed in group A and group B, group A was detected with significantly less intraoperative blood loss (17.6 ± 6.0 mL vs 101.7 ± 62.0 mL, P = 0.003) and shorter postoperative hospital stay (2.4 ± 0.6 days vs 5.2 ± 2.2 days, P < 0.001). Additionally, postoperative drainage was required in group B (35.9 ± 26.4 mL), but none in group A. Follow-up durations averaged 22.8 ± 4.9 months for group A and 20.2 ± 4.2 months for group B. Both groups achieved a significant improvement in VAS, ODI and EQ-5D scores without significant differences. No case experienced neurological deficits and reoperation after surgery in either group. The overall percentage of patients with good to excellent results according to modified MacNab criteria of group A was 95.2%, versus 92.3% of group B.
For the treatment of HM-LDH, large-channel interlaminar endoscopic discectomy is an effective and safe treatment.
高度移位型腰椎间盘突出症（HM-LDH）给外科医生带来了重大挑战。本研究旨在评估大通道椎间孔镜下椎间盘切除术治疗HM-LDH的安全性和临床疗效，并与开放开窗椎间盘切除术进行比较。
纳入2021年1月至2023年12月期间因HM-LDH接受大通道椎间孔镜下椎间盘切除术（A组）或开放开窗椎间盘切除术（B组）的患者。对患者进行至少一年的影像学和临床疗效评估。比较两组的手术时间、术中出血量、术后引流量、术后住院时间、患者报告的疗效及并发症，两组间采用独立样本t检验和Fisher精确概率检验。
本研究共回顾性纳入136例患者，其中A组84例，B组52例。虽然A组和B组的手术时间相似，但A组术中出血量明显较少（17.6±6.0 mL对101.7±62.0 mL，P = 0.003），术后住院时间更短（2.4±0.6天对5.2±2.2天，P < 0.001）。此外，B组需要术后引流（35.9±26.4 mL），而A组无需引流。A组随访时间平均为22.8±4.9个月，B组为20.2±4.2个月。两组的视觉模拟评分（VAS）、腰椎功能障碍指数（ODI）和EQ-5D评分均有显著改善，且无显著差异。两组均未出现神经功能缺损及术后再次手术的病例。根据改良MacNab标准，A组优良率为95.2%，B组为92.3%。
对于HM-LDH的治疗，大通道椎间孔镜下椎间盘切除术是一种有效且安全的治疗方法。
