Abstract:Objective To compare the clinical Results between minimally invasive percutaneous transforaminal endoscopic discectomy(PELD) and microsurgical lumbar discectomy(MSLD) for lumbar disc herniation(LDH).Methods From June 2013 to December 2014, 256 patients with LDH in the Affiliated Provincial Hospital of Anhui Medical University underwent discectomy were enrolled in the research. One hundred and thirty-two patients were treated with MSLD and 124 cases with the PELD.The following measuring instruments were used: Visual analog scale for pain, the Oswestry Disability Index for patients′ function and modified MacNab method for clinical outcome.The perioperative index, relief of the low back and leg pain, and clinical evaluation of each group were documented and compared respectively.Results All patients had been followed up for 5 to 35 months, averaged (20.3±4.8) months and (19.5±5.0) months in the MSLD group and PELD group, respectively. Overall, the PELD group had shorter surgical incision, shorter hospital stay and faster return to work than the MSLD group; however, operating time and radiation exposure were more than MSLD (all P values<0.01). The postoperative ODI and VAS score were significantly improved compared with preoperative ones in 2 groups (all P values<0.05); the VAS of back and leg pain in MSLD group were significantly better than those in the PELD group at 1 and 3 months (all P values<0.01), but no significant difference was found at 6 months and last follow-up (P> 0.05). There was no significant difference in the main clinical outcome criteria ODI between the PELD and the MSLD group. According to the modified MacNab criteria, the excellent and good rates were 94.7%(125/132)and 94.3%(117/124) in the MSLD and PELD groups in the latest follow-up, respectively, and the differences between the 2 groups were not statistically significant (χ2=0.015, P>0.05). There was no incidence of greater artery injury in each group. In MSLD group, there were 2 patients with nerve root traction injury, 1 patient with dural tear. In PELD group, there were 5 patients with postoperative dysesthesia of exiting root, 1 patient with neck pain during operation, and remnant disc fragment was found in one patient with highly migrated disc herniation. There were 2 patients of recurrence with disc herniations in each group, and were all treated with minimally invasive transforaminal lumber iterbody fusion.Conclusions Both PELD and MSLD are effective treatments for patients with LDH, and can get satisfactory clinical Results. PELD have some advantages of less trauma, less pain, less duration of hospital stay, local anesthesia and early function recovery. However, it needs more radiation exposure and operation time, and it is difficult in some special patients (such as large, calcified and highly migrated disc herniations), PELD may be helpful for these patients.
段丽群, 张文志, 贺瑞, 李旭, 葛畅, 张锋, 蔡海平, 王立生. 经皮椎间孔镜与显微镜下微创手术治疗单节段腰椎间盘突出症的对比研究[J]. 中华解剖与临床杂志, 2015, 20(6): 504-509.
Duan Liqun, Zhang Wenzhi, He Rui, Li Xu, Ge Chang, Zhang Feng, Cai Haiping, Wang Lisheng. Comparison of minimally invasive percutaneous transforaminal endoscopic discectomy and microsurgical lumbar discectomy for lumbar disc herniation. Chinese Journal of Anatomy and Clinics, 2015, 20(6): 504-509.
Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery[J]. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
[2]
Weber BR, Grob D, Dvorak J, et al. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle[J]. Spine (Phila Pa 1976), 1997, 22(15): 1765-1772.
[3]
Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). [J]. Surg Technol Int, 1999, 8: 267-277.
[4]
Mysliwiec LW, Cholewicki J, Winkelpleck MD, et al. MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection[J]. Eur Spine, 2010, 19(7): 1087-1093.
[5]
Maroon JC. Current concepts in minimally invasive disceetomy[J]. Neurosurgery, 2002, 51(5 Suppl): S137-S145.
[6]
literno JA, Knopman J, Parikh K, et al. Results and risk factors or recurrence following single-level tubular lumbar microdiscectomy[J]. J Neurosurg Spine, 2010, 12(6): 680-686.
[7]
Lee SH, Chung SE, Ahn Y, et al. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis[J]. Mt Sinai J Med, 2006, 73(5): 795-801..
[8]
Ruetten S, Komp M, Merk M. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study[J]. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
[9]
Choi G, Kang HY, Modi HN, et al. Risk of developing seizure after percutaneous endoscopic lumbar discectomy[J]. J Spinal Disord Tech, 2011, 24(2): 83-92.
[10]
Lee SH, Kang BU, Ahn Y, et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases[J]. Spine (Phila Pa 1976), 2006, 31(10): E285-E290.
Choi G, Lee HS, Lokhande P, et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope[J]. Spine (Phila Pa 1976), 2008,33(15): E508-E515.
[13]
Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: Prospective 2-year results of 331 patients[J]. Minim Invasive Neurosurg, 2006, 49(2): 80-87.
[14]
Choi G, Prada N, Modi HN, et al. Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4-L5 disc through an L5-S1 interlaminar approach: a technical note[J]. Minim Invas Neurosurg, 2010, 53(3): 147-152.
[15]
Ahn Y, Lee SH, Lee JH, et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome,prognostic factors, and technical consideration[J]. Acta Neurochir(Wien), 2009, 151(3): 199-206.
[16]
Lübbers T, Abuamona R, Elsharkawy AE. Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level[J]. Acta Neurochir(Wien), 2012, 154(10): 1789-1795.
[17]
Jang JS, An SH, Lee SH. Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumbar disc herniations[J]. J Spinal Disord Tech, 2006, 19(5): 338-43.
[18]
Cho JY, Lee SH, Lee HY. Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: floating retraction technique[J]. Minim Invas Neurosurg, 2011, 54(5-6): 214-218.
Theocharopoulos N, Perisinakis K, Damilakis J, et al. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery[J]. J Bone Joint Surg (Am), 2003, 85-A(9): 1698-1703.
[21]
Ng CY, Gibson JN. An aid to the explanation of surgical risks and complications: the International Spinal Surgery Information Sheet[J]. Spine (Phila Pa 1976), 2011, 36(26): 2333-2345.
[22]
Cheng J, Wang H, Zheng W, et al. Reoperation after lumbar disc surgery in two hundred and seven patients[J] Int Orthop, 2013, 37(8): 1511-1517.
[23]
Kim CH, Chung CK, Park CS, et al. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study[J]. Spine(Phila Pa 1976), 2013, 38(7): 581-590.
[24]
Kim JM, Lee SH, Ahn Y, et al. Recurrence after successful percutaneous endoscopic lumbar discectomy[J]. Minim Invas Neurosurg, 2007, 50(2): 82-85.
[25]
Ahn Y. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications[J]. Expert Rev Med Devices, 2012, 9(4): 361-366.