Percutaneous lumbar discectomy in the treatment of lumbar discitis

Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14–59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.     

Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis

Background:

Hematogeneous infectious spondylodiscitis usually occurs in older immunocompromised patients with other comorbidities. They are usually unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method of transpedicular curettage and drainage was suggested. This study was designed to compare the surgical outcomes for the treatment of hematogeneous infectious spondylodiscitis between transpedicular curettage and drainage technique and conventional combined anterior and posterior surgery.

Materials and Methods:

Between January 2002 and July 2011, 26 patients underwent surgical treatment for hematogeneous infectious spondylodiscitis. The patients were classified into two groups depending on surgical modality: a transpedicular curettage and drainage (TCD) group and a combined anterior and posterior surgery (CAPS) group.

Results:

The TCD group consisted of 10 patients (mean age 68.0 years), and the CAPS group consisted of 16 patients (mean age 58.4 years). The mean postoperative followup periods were 36.9 (months) in the TCD group and 69.9 (months) in the CAPS group. The operation time was 180.6 ± 33.6 minutes in the TCD group and 332.7 ± 74.5 minutes in the CAPS group (P < 0.05). Postoperative independent ambulation began at postoperative 4.9 ± 2.4 days in the TCD group but at postoperative 15.1 ± 15.3 days in the CAPS group (P < 0.05). The postoperative hospital stays were 19.9 ± 7.8 days in the TCD group and 35.4 ± 33.3 days in the CAPS group (P < 0.05). The level of C-reactive proteins decreased significantly in both groups after surgery (P < 0.05).

Conclusion:

Transpedicular curettage and drainage technique proved to be a useful technique for treating hematogeneous infectious spondylodiscitis in patients who were in poor heath with multiple comorbidities unable to undergo the conventional combined anterior and posterior surgery in a single day in terms of earlier ambulation, shorter hospitalization and similar clinical success rate.     

Percutaneous discectomy of the lumbar spine

Summary Ten patients with clinical and radiological evidence of herniated discs at lower lumbar levels were treated with partial discectomy by a lateral percutaneous approach. Eight patients had complete relief from radicular pain and were discharged within four days. They returned to normal daily activity within one month.

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Résumé Dix malades présentant des signes cliniques et radiologiques de hernie discale L3–L4 et L4–L5 ont été traités par discectomie partielle, effectuée par voie per-cutanée à l'aide d'un trocart introduit par voie postéro-externe. Huit de ces patients ont été totalement soulagés de leurs douleurs et ont pu quitter l'hôpital au 4e jour. Ils ont repris une activité normale dans un délai d'un mois.

     

Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess

Summary Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9–10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess. Correspondence: Dr. Mehmet Turgut, Cumhuriyet Mahallesi, Cumhuriyet Caddesi, No: 6 Daire: 7, TR-09020 Aydın, Turkey.     

一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染

目的:探讨一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的临床疗效及意义。方法:回顾性分析2011年3月~2015年1月我院收治并应用一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗的13例L5/S1椎间隙感染患者,其中男8例,女5例;年龄28~60岁(41.6±11.0岁);记录患者术中手术时间、出血量、术后并发症,记录术前、术后腰部疼痛视觉模拟评分(visual analogue scale,VAS)评估临床症状,术前术后腰骶角(lumbosacral angle,LSA)评估腰骶段前凸恢复情况。结果:所有手术均顺利完成,手术后1例出现逆行性射精,1例患者发生单侧下肢肌间静脉血栓,未出现严重并发症;前路手术时间为70~120min(90.0±27.5min),失血量为200~600ml(361.5±150.2ml);后路手术时间为50~70min(57.7±8.3min),失血量为50~200ml(106.9±56.9ml)。术后培养结果其中7例为金黄色葡萄球菌感染,3例为大肠杆菌,1例为铜绿假单胞菌,2例未见细菌生长,但病理检查结果提示感染性病变。病例均获随访,时间6~30个月(16.6±7.8个月)。末次随访时所有患者均达临床愈合,骨融合率100%,随访期内未见复发病例。VAS评分术前平均7.8±0.7分,术后6个月平均1.3±0.5分,与术前比较差异有统计学意义(P0.05);LSA术前4.4°±2.9°,末次随访时17.5°±2.8°,与术前比较有统计学意义(P0.05)。结论:一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的手术创伤小、固定可靠、疗效确切,可以作为治疗L5/S1椎间隙感染的一种手术方法。     

Decompression alone versus fusion for pyogenic spondylodiscitis

Background Context

A spinal infection is a serious problem for a spine surgeon, and there is currently much debate regarding how best to treat pyogenic spondylodiscitis using antibiotics and the instrumentations that have been developed to date.

化脓性肝脓肿的经皮引流和抗菌药物治疗

本文报告１９８５年以来用经皮引流和抗菌药物为主治疗２４８例肝脓肿的经验，９５．２％的病例经Ｂ超检查确诊，有明确脓腔的脓肿行经皮置管引流或穿刺吸脓共１０５例；未液化的８９例脓肿，给以抗菌药物及支持治疗，手术治疗５４例，为肝脓肿破溃腹膜炎，或胆源性肝脓肿需急诊处理胆道病变，或经皮引流不畅中转手术。作者认为，由于Ｂ超用于诊断和鉴别以及新一代抗生素的应用，肝脓肿的预后已大为改善，本组死亡率为１．６％，经皮     

经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的疗效对比

目的比较经皮内镜和椎板开窗髓核摘除术治疗单节段单侧腰椎间盘出症的临床效果及优缺点。方法回顾性分析自2011-01—2014-01诊治的278例腰椎间盘突出症,采用经皮内镜腰椎间盘切除术治疗142例,采用椎板开窗髓核摘除术治疗136例。结果椎板开窗髓核摘除术出血量多和时间短,并发症多,2组比较差异有统计学意义(P0.05);术后2周、3个月和6个月Macnab标准优良率2组比较,经皮内镜腰椎间盘切除术优于椎板开窗髓核摘除术,差异均有统计学意义(P0.05)。结论 2种术式都能有效缓解腰椎间盘突出症患者的症状,但经皮内镜腰椎间盘切除术后并发症发生率低,是理想的微创治疗腰椎间盘突出症的方法。     

经皮对侧椎间孔入路内窥镜下椎间盘切除术治疗游离型腰椎间盘突出症

【摘要】 目的：探讨经皮对侧椎间孔入路内窥镜下腰椎间盘切除术（percutaneous endoscopic lumbar discecto?鄄my,PELD）治疗游离型腰椎间盘突出症的可行性及安全性。方法：2010年2月～2012年2月采用经对侧椎间孔入路PELD治疗游离型腰椎间盘突出症患者12例,均为单节段椎间盘突出,其中L3/4 3例,L4/5 9例,观察患者术中情况及手术耐受性,记录手术时间及术后并发症。通过术前和术后下肢放射痛VAS评分、功能障碍指数（Oswestry disability index,ODI）评估患者术后改善情况,使用改良Macnab疗效评定标准评估手术疗效。结果：12例患者均顺利完成手术,术中患者耐受性好,手术时间110±20min。1例术后马尾神经损伤症状加重,保守治疗3个月后症状缓解,余病例无神经、血管、硬膜囊损伤等并发症发生。随访12～24个月,平均18±2.5个月,下肢放射痛及日常生活功能均有明显改善,术后下肢放射痛VAS评分由术前7.75±0.97分减少到术后第一天的2.42±0.79分,末次随访时为1.42±0.79分,与术前比较均有显著性差异（P<0.0001）;OID评分由术前57.67±9.57减少到末次随访时的8.50±3.73,差异有显著性（P<0.0001）。末次随访时改良Macnab疗效评定优8例,良3例,可1例,优良率为91.67%（11/12）。结论：经对侧椎间孔入路PELD治疗游离型腰椎间盘突出症是一种安全、可行的手术方法。     

Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches

Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic classification of disc migration and surgical approaches of PELD according to the classification. A prospective study of 116 consecutive patients undergoing single-level PELD was conducted. According to preoperative MRI findings, disc migration was classified into four zones based on the direction and distance from the disc space: zone 1 (far up), zone 2 (near up), zone 3 (near down), zone 4 (far down). Two surgical approaches were used according to this classification. Near-migrated discs were treated with "half-and-half" technique, which involved positioning a beveled working sheath across the disc space to the epidural space. Far-migrated discs were treated with "epiduroscopic" technique, which involved introducing the endoscope into the epidural space completely. The mean follow-up period was 14.5 (range 9-20) months. According to the Macnab criteria, satisfactory results were as follows: 91.6% (98/107) in the down-migrated discs; 88.9% (8/9) in the up-migrated discs; 97.4% (76/78) in the near-migrated discs; and 78.9% (30/38) in the far-migrated discs. The mean VAS score decreased from 7.5 +/- 1.7 preoperatively to 2.6 +/- 1.8 at the final follow-up (P < 0.0001). There were no recurrence and no approach-related complications during the follow-up period. The proposed classification and approaches will provide appropriate surgical guideline of PELD for migrated disc herniation. Based on our results, open surgery should be considered for far-migrated disc herniations.     

细菌性肝脓肿经皮穿刺与手术治疗疗效的比较

目的：比较细菌性肝脓肿经皮穿刺与手术治疗的疗效。方法：回顾分析首都医科大学宣武医院1989年1月—2008年12月收治的193例细菌性肝脓肿患者的临床资料,按治疗方法分为经皮穿刺组（96例）及手术治疗组（97例）,比较2组的治疗成功率、并发症率、死亡率及住院时间。结果：2组患者的性别,年龄,糖尿病有无,白蛋白水平,脓肿的部位、个数、大小、来源等差异均无统计学意义。经皮穿刺组患者治疗成功率、死亡率及平均住院时间分别为87.5%（84/96）、2.1%（2/96）、（20.8±12.4）d;手术组为94.8%（92/97）、2.1%（2/97）、（18.9±13.5）d,差异均无统计学意义（P=0.072,1.000,0.575）。经皮穿刺组并发症率较手术组低（2.1%vs9.3%,P=0.037）。结论：经皮穿刺治疗细菌性肝脓肿与手术同样有效,且并发症率较低,应成为肝脓肿治疗的首选。     

Clinical outcomes of percutaneous suction aspiration and drainage for the treatment of infective spondylodiscitis with paravertebral or epidural abscess

Background Context

Patients with infective spondylodiscitis who failed conservative treatment are generally indicated for open surgery. However, some patients are poor candidates for standard surgery, hence the need to evaluate less invasive approaches. Good outcomes were previously reported for percutaneous suction aspiration and drainage (PSAD) in the treatment of infective spondylodiscitis resistant to conservative therapy. We recently extended the surgical approach of PSAD to allow drainage of paravertebral or epidural abscesses in patients with progressive infective spondylodiscitis.

经皮椎间孔镜联合硬膜外注射治疗脱出型腰椎间盘突出症

目的:评价经皮椎间孔镜联合硬膜外注射治疗脱出型腰椎间盘突出症的疗效。方法 :对2014年3月至2015年6月接受经皮椎间孔镜下髓核摘除术的126例单节段脱出型腰椎间盘突出症患者进行前瞻性随机对照研究,男67例,女59例;年龄17~75岁,平均(41.0±13.5)岁;L3,49例,L4,576例,L5S141例。按随机数字表中随机数的奇数和偶数随机分为单纯椎间孔镜组和椎间孔镜联合硬膜外注射组,每组63例。单纯椎间孔镜组行经皮椎间孔镜下髓核摘除术后注入4 ml生理盐水,椎间孔镜联合硬膜外注射组行经皮椎间孔镜下髓核摘除术后注入1 ml复方倍他米松、1 ml利多卡因和2 ml甲钴胺。随访时间6~20个月,平均12.4个月,比较两组并发症情况,术后住院时间,恢复工作时间,疼痛视觉类比评分(visual analogue scale,VAS)和JOA评分,按改良Mac Nab标准评定临床疗效。结果:所有病例顺利完成手术,未见并发症。单纯椎间孔镜组术后住院时间和恢复工作时间分别(4.61±1.25)d、(4.31±0.47)周,椎间孔镜联合硬膜外注射组分别为(2.53±0.69)d、(3.14±0.52)周,两组差异有统计学意义(P=0.000)。两组术后VAS评分、JOA评分与术前比较,均明显改善(P=0.000)。椎间孔镜联合硬膜外注射组术后1 d、1周、1个月的VAS评分及JOA评分均优于单纯椎间孔镜组(P=0.000)。术后6个月两组VAS评分及JOA评分差异无统计学意义(P0.05)。术后按照改良Mac Nab标准评定疗效,单纯椎间孔镜组优39例,良21例,可3例;椎间孔镜联合硬膜外注射组优41例,良20例,可2例;两组差异无统计学意义(P=0.087)。结论 :经皮椎间孔镜治疗脱出型腰椎间盘突出症创伤小,疼痛缓解明显,功能恢复好。术中联合使用硬膜外注射短期内疼痛缓解及功能改善更加显著,可减少术后住院时间,早日恢复工作,是一种安全有效的手段。     

Ralstonia mannitolilytica as a rare cause of spondylodiscitis following endoscopic lumbar discectomy- A report of two cases

Ralstonia mannitolilytica is a low-virulence, gram-negative bacillus which causes opportunistic infections in immunosuppressed patients. Postoperative spondylodiscitis by R. mannitolilytica has not been reported so far. We report the management of two cases of postoperative spondylodiscitis caused by Ralstonia mannitolilytica presenting to our center within a span of one month following endoscopic lumbar discectomy at a different center. They were managed successfully by surgical debridement and appropriate antibiotics. In these two cases of R.mannitolilytica spondylodiscitis, prompt detection, and intensive treatment resulted in satisfactory outcomes in terms of fulfilling the purpose of the original surgery.     

单侧双通道内镜下椎间盘切除术与经皮内镜下经椎间孔入路椎间盘切除术治疗腰椎间盘突出症的临床疗效对比

【摘要】 目的：比较单侧双通道内镜下椎间盘切除术（unilateral biportal endoscopic discectomy,UBED）与经皮内镜下经椎间孔入路椎间盘切除术（percutaneous endoscopic transforaminal discectomy,PETD）治疗单节段腰椎间盘突出症（lumbar disc herniation,LDH）的短期临床疗效。方法：回顾性分析2020年3月～2020年6月我院分别应用UBED（UBED组）和PETD（PETD组）治疗单节段LDH患者56例,UBED组29例,其中男17例,女12例,年龄59.6±10.5岁,随访时间13.5±2.7个月。PETD组27例,其中男14例,女13例,年龄60.3±12.3岁,随访时间13.8±2.9个月。两组患者的年龄、性别、BMI、随访时间等一般资料均无统计学差异（P＞0.05）。记录并比较两组患者手术时间、术中透视次数、出血量、手术前后血红蛋白值和术后并发症等。使用视觉模拟量表（visual analogue scale,VAS）评分及Oswestry功能障碍指数（Oswestry disability index,ODI）评价两组患者术前、术后3天、术后3个月及术后1年的生活质量,术后1年通过改良MacNab标准评价疗效,比较两组间是否存在差异。结果：所有患者均顺利完成手术。UBED组患者术中出血量较PETD组多（49.6±15.6ml vs 25.3±9.7ml,P<0.05）,术中透视次数少（3.35±0.81次 vs 7.71±1.73次,P<0.05）。两组手术时间、术后并发症无统计学差异（P>0.05）。两组患者术前、术后血红蛋白值和血红蛋白减少值均无统计学差异（P>0.05）。两组患者术后3天、术后3个月及术后1年腰腿痛VAS评分和ODI较术前均明显下降（P<0.05）,两组患者各时间点腰腿痛VAS评分及ODI均无统计学差异（P>0.05）。术后两组优良率差异无统计学差异（89.7% vs 88.9%,P>0.05）。结论：UBED与PETD治疗LDH均安全有效,与PETD相比,UBED可获得相似的疼痛缓解,改善患者的生活质量。UBED术中出血较PETD增加,但手术前后血红蛋白变化相当,UBED可有效减少术中透视次数。     

Percutaneous endoscopic lumbar discectomy (PELD)

Percutaneous endoscopic lumbar discectomy (PELD) is a new technique for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. The technique was introduced in Germany by the authors in April 1987. The method is indicated in patients with non-equestrated lumbar disc herniation with an intact lorsal longitudinal ligament. In local anesthesia, a working cannula (OD 5 mm) is placed at the dorsal lateral border of the disc. The disc space is opened with anulus trephines and the nucleus pulposus is removed with rigid and flexible forceps as well as with automated shaver systems under intermittent endoscopic control (discoscopy). The procedure is performed in local anesthesia. The results of the first thirty patients with a follow-up time between 6 months and 17 months could be graded as excellent in 13 cases, as good in 9 cases, as fair in 6 cases, and as bad in 2 cases. The relief of symptoms as judged by the patients was between 70–100 percent in the majority of the cases. Three patients had to be reoperated at the same level and site, because of either persistent or recurrent sciatica. The performance in local anesthesia, the atraumatic extraspinal approach, the reduced time of hospitalization and post-operative morbidity as well as the reduced time of work incapability are the main advantages of this new method.     

Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis

Background

The primary management of pyogenic spondylodiscitis is conservative. Once the causative organism has been identified, by blood culture or biopsy, administration of appropriate intravenous antibiotics is started. Occasionally patients do not respond to antibiotics and surgical irrigation and debridement is needed. The treatment of these cases is challenging and controversial. Furthermore, many affected patients have significant comorbidities often precluding more extensive surgical intervention. The aim of this study is to describe early results of a novel, minimally invasive percutaneous technique for disc irrigation and debridement in pyogenic spondylodiscitis.

Materials and methods

A series of 10 consecutive patients diagnosed with pyogenic spondylodiscitis received percutaneous disc irrigation and debridement. The procedure was performed by inserting two Jamshidi needles percutaneously into the disc space. Indications for surgery were poor response to antibiotic therapy (8 patients) and the need for more extensive biopsy (2 patients). Pre- and postoperative white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Oswestry disability index (ODI), and visual analogue score (VAS) for back pain were collected. Minimum follow-up was 18 months, with regular interval assessments.

Results

There were 7 males and 3 females with a mean age of 67 years. The mean WBC before surgery was 14.63?×?10⁹/L (10.9–26.4) and dropped to 7.48?×?10⁹/L (5.6–9.8) after surgery. The mean preoperative CRP was 188 mg/L (111–250) and decreased to 13.83 mg/L (5–21) after surgery. Similar improvements were seen with ESR. All patients reported significant improvements in ODI and VAS scores after surgery. The average hospital stay after surgery was 8.17 days. All patients had resolution of the infection, and there were no complications associated with the procedure.

Conclusions

Our study confirms the feasibility and safety of our percutaneous technique for irrigation and debridement of pyogenic spondylodiscitis. Percutaneous irrigation and suction offers a truly minimally invasive option for managing recalcitrant spondylodiscitis or for diagnostic purposes. The approach used is very similar to discography and can be easily adapted to different hospital settings.

Level of Evidence

Level III

     

经皮内窥镜下手术治疗腰椎间盘突出症的并发症及其防治策略

目的:总结经皮内窥镜下腰椎间盘切除术(PELD)治疗腰椎间盘突出症的手术并发症,并探讨其防治策略。方法:2005年5月~2011年12月采用PELD共治疗腰椎间盘突出症患者893例(YESS技术234例,TESSYS技术659例),男524例,女369例;年龄14～83岁,平均44.3岁。46例为复发性腰椎间盘突出症。患者均存在明显腰腿痛,并经CT及MRI检查证实为腰椎间盘突出或术后复发,无椎间盘钙化或椎体后缘离断及腰椎不稳或滑脱;经保守治疗3个月以上无效。旁中央型突出371例,外侧型突出417例,极外侧型突出37例,游离型突出58例,中央型突出10例;L2/3 4例,L3/4 26例,L4/5 552例,L5/S1 296例,L3/4、L4/5 10例,L4/5、L5/S1 5例。均在局麻及影像监视下行PELD。观察术中、术后并发症及其处理方法。结果:共发生并发症59例次,发生率为6.61%。其中6例髓核部分残留患者残留髓核压迫神经根,再次行后路内窥镜下椎间盘切除术(MED)后痊愈。1例术中硬脊膜撕裂,为复发性椎间盘突出症患者,术中即发现脑脊液渗漏,予胶原蛋白海绵覆盖破口,严密缝合伤口并加压包扎后痊愈。3例神经损伤,均为一期行同侧L3/4、L4/5 PELD患者,予以神经营养、理疗等治疗,2例术后3～6个月内完全恢复,1例未恢复。2例术后椎间隙感染,经抗感染、卧床休息等保守治疗后痊愈。1例发生腹膜后血肿,予以加压包扎、卧床休息,血肿逐渐吸收。24例患者术后出现感觉异常,经神经营养及理疗1~3周后均恢复。术后随访6~75个月,平均31.6个月,共有22例复发,14例二次行MED术,8例行微创腰椎融合术(MIS-TLIF)。结论:PELD手术的并发症并不少见,应严格掌握手术适应证,提高手术技巧,并做好相应的应对措施。     

经皮椎间盘镜腰椎间盘突出髓核摘除术108例报告

本文报告用经皮椎间盘镜腰椎间盘摘除系统行腰椎间盘髓核摘除术108例的临床经验.本组穿刺成功率100%,近期随访优良率91.6%.该手术具有创伤小、出血少、恢复快、对脊柱稳定性无影响的优点.为腰椎间盘突出的治疗开辟了一条新的途径.     

经皮内窥镜腰椎间盘切除术与开放腰椎间盘摘除术治疗的临床对比研究

目的比较经皮内窥镜腰椎间盘切除术(PELD)和开放腰椎间盘摘除术(OLD)的临床疗效。方法对100例腰椎间盘突出症根据手术方法不同,分为PELD组和OLD组。手术效果按照Oswestry功能障碍指数(ODI)、疼痛视觉类比评分(VAS)和改良的MacNab标准评定。结果PELD组平均随访24.3个月,单个节段平均手术时间60min,失血11ml,术后卧床24h。OLD组平均随访24.5个月,单个节段平均手术时间50min,失血30ml,术后卧床120h。两组采用改良MacNab标准评定随访结果,PELD组优良率为92%,OLD组96%。PELD组和OLD组术后ODI、VAS与术前比较,明显改善(P<0.05)。结论在严格选择手术适应证的情况下,PELD和OLD具有相似的近期临床疗效,但是PELD具有切口小、创伤小和术后恢复较快等优点。