Clinical outcomes of patients with lumbar disc herniation with lateral recess stenosis treated by percutaneous transforaminal endoscopic lumbar discectomy
YANG Gang TIAN Yafeng YU Jian ZHU Yanfeng HAN Kun DONG Junge
The First Department of Osteology, Hebei Provincial Traditional Chinese Meditional Hospital, Hebei Province, Shijiazhuang 050017, China
Abstract Objective To evaluate the outcome and safety of percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation with lateral recess stenosis. Method A total of 85 patients with lumbar disc herniation admitted to the First Department of Osteology, Hebei Hospital of Traditional Chinese Medicine from August 2014 to August 2019 were selected as the study subjects. All patients received PELD, and 70 patients were followed up for two years. Postoperative MRI or CT examination was performed. Clinical outcomes were evaluated using the visual analog scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria at three, six month, one, and two year after surgery. Results 70 patients were followed up for two years, including three patients with the L3-4 lumbar segment, 57 patients with the L4-5 lumbar segment, 10 patients with the L5-S1 lumbar segment, 31 males and 39 females. The age range was 44 to 75 years old, with a mean of (54.2±7.7) years old. All patients underwent PELD for nucleus pulposus removal and lateral recess enlargement decompression. Three patients with transient postoperative sensory disturbance were L5-S1 segment patients, and postoperative MRI/CT examination showed sufficient decompression. None of the patients developed postoperative infection, dysfunction, nerve root injury, or iatrogenic segmental instability. The VAS scores and ODI values of the 70 patients were lower than those before surgery at all follow-up time points, and the differences were statistically significant (P＜0.05). MacNab score two years after surgery, 24 cases were excellent, 39 cases were good, 6 cases were fair, and 1 case was poor. The rate of excellent and good was 90.0%. Conclusion PELD is a less invasive, effective and safe surgery for lumbar disc herniation with lateral recess stenosis.
YANG Gang TIAN Yafeng YU Jian ZHU Yanfeng HAN Kun DONG Junge. Clinical outcomes of patients with lumbar disc herniation with lateral recess stenosis treated by percutaneous transforaminal endoscopic lumbar discectomy[J]. 中国医药导报, 2022, 19(36): 36-40.
[1] Smorgick Y，Park DK，Baker KC，et al. Single- versus multilevel fusion for single-level degenerative spondylolisthesis and multilevel lumbar stenosis：four-year results of the spine patient outcomes research trial [J]. Spine，2013，38（10）：797-805.
[2] Weinstein JN，Tosteson TD，Lurie JD，et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis [J]. N Engl J Med，2008，358（8）：794-810.
[3] Kitahama Y，Sairyo K，Dezawa A. Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis，herniated nucleus pulposus and pulmonary comorbidities [J]. Asian J Endosc Surg，2013，6（2）：130-133.
[4] Knight MT，Jago I，Norris C，et al. Transforaminal endoscopic lumbar decompression & foraminoplasty： a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery [J]. Int J Spine Surg，2014， 8：21.
[5] Kim M，Kim HS，Oh SW，et al. Evolution of spinal endoscopic surgery [J]. Neurospine，2019，16（1）：6-14.
[6] Pan M，Li Q，Li S，et al. Percutaneous endoscopic lumbar discectomy：indications and complications [J]. Pain Physician，2020，23（1）：49-56.
[7] Choi G，Lee SH，Lokhande P，et al. Percutaneousendoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope [J]. Spine，2008，33（15）：e508-515.
[8] Lewandrowski KU. Outside-in technique，clinical results，and indications with transforaminal lumbar endoscopic surgery：a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis [J]. Int J Spine Surg，2014，8：26.
[9] 李子荣.腰椎管侧隐窝狭窄症[J].国外医学外科分册，1985， 12（3）：131-133.
[10] Behrend CJ，Sch?觟nbach EM，Vaccaro AR，et al. Maximum pain on visual analog scales in spinal disorders [J]. Spine J，2017，17（8）：1061-1065.
[11] Fairbank JC，Pynsent PB. The Oswestry disability index [J]. Spine，2000，25（22）：2940-2952.
[12] Macnab I. Negative disc exploration An analysis of the causes of nerve-root involvement in sixty-eight patients [J]. J Bone Joint Surg Am，1971，53（5）：891-903.
[13] 张强.CT影像对腰椎间盘突出症合并侧隐窝狭窄诊断的临床应用[J].当代医学，2010，16（34）：80-81.
[14] 金军，袁燕，申文，等.椎间孔镜技术两种手术入路在治疗单节段退行性腰椎管狭窄症中的临床应用比较[J].中国内镜杂志，2020，26（6）：59-63.
[15] Liu J，Zhang H，Zhang X，et al. Percutaneous endoscopic decompression for lumbar spinal stenosis： Protocol for a systematic review and network meta-analysis [J]. Medicine，2019，8（20）：e15635.
[16] 杨晋才，海涌，丁一，等.经皮内镜辅助下经椎间孔腰椎减压融合术治疗腰椎管狭窄症[J].中华医学杂志，2018， 98（45）：3711-3715.
[17] Cheng XK，Chen B. Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Central Spinal Stenosis and Degenerative Lumbar Spondylolisthesis：A Novel Surgical Technique and Clinical Outcomes [J]. Clin Interv Aging，2020，15：1213-1219.
[18] 甘璐，李沫，杜俊杰.经髂骨钻孔入路椎间孔镜手术与传统后入路椎板开窗髓核摘除术治疗高髂嵴L5/S1椎间盘突出症的短期疗效比较[J].微创医学，2020，15（2）：134-137.
[19] Li ZZ，Hou SX，Shang WL，et al. The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach [J]. Clin Neurol Neurosurg，2015，133：40-45.
[20] Li Y，Wang B，Wang S. Full-Endoscopic Decompression for Lumbar Lateral Recess Stenosis via an Interlaminar Approach versus a Transforaminal Approach [J]. World Neurosurg，2019，128：e632-e638.
[21] Osman SG，Nibu K，Panjabi MM，et al. Transforaminal and posterior decompressions of the lumbar spine：a comparative study of stability and intervertebral foramen area [J]. Spine，1997，22（15）1690-1695.
[22] 王玉，孔清泉，宋跃明.精准椎间孔成形减压术治疗腰椎侧隐窝狭窄症的近期疗效分析[J].中国修复重建外科杂志，2017，31（11）：1334-1340.
[23] 孙宜保，杨勇，祝孟坤，等.脊柱内镜可视化技术治疗腰椎侧隐窝狭窄症的近期疗效[J].临床骨科杂志，2021， 24（3），331-334.
[24] Nowitzke AM. Assessment of the learning curve for lumbar microen-doscopicdiscectomy [J]. Neurosurgery，2005，56（4）：755-762.
[25] 李彦，商澜镨，刘晓光，等.经皮脊柱内镜手术教学培训模式的探索[J].中国疼痛医学杂志，2019，25（3）：199- 203.
