Abstract：Objective To observe the clinical efficacy, surgical techniques, and complications of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar disc herniation with single- segment prolapse. Methods The clinical data of 40 patients (including 22 males and 18 females, aged 18-52 years old, with an average age of 32 years) with single-segment prolapse and free lumbar disc herniation from January 2018 to March 2019 in Wuxi People's Hospital affiliated to Nanjing Medical University were retrospectively analyzed. The diseased segment included L3/4 (4 cases), L4/5 (29 cases), and L5/S1 (7 cases). According to the Lee classification criteria, the severity of lumbar disc herniation was type Ⅰ in 3 cases, type Ⅱ in 7 cases, type Ⅲ in 21 cases, and type Ⅳ in 9 cases. All 40 patients were treated with PELD, 34 and 6 of which underwent the foraminal approach and interlaminar approach, respectively. The patients' postoperative recovery and complications were observed, and patients' visual analogue scale (VAS) and Oswestry disability index (ODI) were compared before operation and 1 day, 1 month, and 6 months after operation. At 6 months after the operation, the MRI was reviewed to determine whether the nucleus pulposus relapsed. The MacNab standard was used to evaluate the efficacy at 6 months after surgery. Results The operation was successfully conducted in all patients. The operation time was 45.9-72.0 (59.8±12.5) min. The intraoperative blood loss of all patients was less than 18 mL. One case of intervertebral space infection occurred in a postoperative patient with the foraminal approach, and one patient had residual symptoms after an interlaminar approach. All 40 patients were followed up after surgery. The follow-up time was 6-12 (8.2±2.7) months. The VAS scores were (2.3±0.7), (0.8±0.3), and (0.3±0.1) 1 day, 1 month, and 6 months after surgery, and the ODI was 21.3%±3.4%, 11.9%±2.9%, and 3.1%±1.5%, respectively, which were all lower than the preoperative values (7.2±1.3) and (62.8%±5.5%). The difference was statistically significant (F=10.812, 8.750, all P values＜0.05). MRI was re-examined 6 months after the operation. One patient that underwent the interlaminar approach had residual prolapsed nucleus pulposus, and none of the remaining patients showed residual nucleus pulposus or recurrence. According to the MacNab standard, the curative effect was evaluated at 6 months after operation. Thirty-six cases were rated as excellent, two cases were good, and two cases were fair. The rating of excellent and good curative effect was 95.0%. Conclusions PELD has satisfactory clinical effects in the treatment of single-segment prolapsed lumbar intervertebral disc herniation; however, treating patients with high prolapse and tail displacement is still challenging for surgeons.
陆彬彬, 高爱国, 金祺, 周颖川, 王烨, 张钦, 李丁, 顾晓峰. 经皮椎间孔镜下椎间盘摘除术治疗单节段脱垂型腰椎间盘突出症的疗效观察[J]. 中华解剖与临床杂志, 2020, 25(6): 668-672.
Lu Binbin, Gao Aiguo, Jin Qi, Zhou Yingchuan, Wang Ye, Zhang Qin, Li Ding, Gu Xiaofeng. Percutaneous discectomy for the treatment of lumbar disc herniation with single-segment prolapse. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 668-672.
Ahn Y, Jang IT, Kim WK.Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation[J]. Clin Neurol Neurosurg, 2016, 147: 11-17. DOI:10.1016/j.clineuro.2016.05.016.
[2]
Gadjradj PS, van Tulder MW, Dirven CM, et al. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series[J]. Neurosurg Focus, 2016, 40(2): E3. DOI:10.3171/2015.10.FOCUS15484.
[3]
Choi KC, Kim JS, Park CK.Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation[J]. Pain Physician, 2016, 19(2): E291-E300.
[4]
Kim CH, Chung CK, Woo JW.Surgical outcome of percutaneous endoscopic interlaminar lumbar discectomy for highly migrated disk herniation[J]. Clin Spine Surg, 2016, 29(5): E259-E266. DOI:10.1097/BSD.0b013e31827649ea.
[5]
Hua W, Tu J, Li S, et al.Full-endoscopic discectomy via the interlaminar approach for disc herniation at L4-L5 and L5-S1: an observational study[J]. Medicine(Baltimore), 2018, 97(17): e0585. DOI:10.1097/MD.0000000000010585.
[6]
Dabo X, Ziqiang C, Yinchuan Z, et al.The clinical results of percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of calcified lumbar disc herniation: a case-control study[J]. Pain Physician, 2016, 19(2): 69-76.
[7]
Sencer A, Yorukoglu AG, Akcakaya MO, et al.Fully endoscopic interlaminar and transforaminal lumbar discectomy: short-term clinical results of 163 surgically treated patients[J]. World Neurosurg, 2014, 82(5): 884-890. DOI:10.1016/j.wneu.2014.05.032.
[8]
Hsu HT, Chang SJ, Yang SS, et al.Learning curve of full-endoscopic lumbar discectomy[J]. Eur Spine J, 2013, 22(4): 727-733. DOI:10.1007/s00586-012-2540-4.
[9]
Hirano Y, Mizuno J, Takeda M, et al.Percutaneous endoscopic lumbar discectomy-early clinical experience[J]. Neurol Med Chir (Tokyo), 2012, 52(9): 625-630. DOI:10.2176/nmc.52.625.
[10]
Wagner R, Telfeian AE, Iprenburg M, et al.Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation[J]. World Neurosurg, 2016, 90: 194-198. DOI:10.1016/j.wneu.2016.02.086.
[11]
Ahn SS,Kim SH,Kim DW,et al.Comparison of outcomes of percu- taneous endoscopic lumbar discectomy and open lumbar microdis- cectomy for young adults: a retrospective matched cohort study[J]. World Neurosurg, 2016, 86: 250-258. DOI:10.1016/j.wneu.2015.09.047.
[12]
Ying J, Huang K, Zhu M, et al.The effect and feasibility study of transforaminal percutaneous endoscopic lumbar discectomy via superior border of inferior pedicle approach for down-migrated intracanal disc herniations[J]. Medicine (Baltimore), 2016, 95(8): e2899. DOI:10.1097/MD.0000000000002899.
[13]
Ahn SS, Kim SH, Kim DW.Learning curve of percutaneous endoscopic lumbar discectomy based on the period (early vs. late) and technique (in-and-out vs. in-and-out-and-in): a retrospective comparative study[J]. J Korean Neurosurg Soc, 2015, 58(6): 539-546. DOI:10.3340/jkns.2015.58.6.539.
2020, Vol. 25 
