经皮椎间孔镜治疗腰椎管狭窄症的体会

目的探讨经皮椎间孔镜技术治疗腰椎管狭窄症的重要性和有效性。方法采用经皮椎间孔镜技术治疗35例腰椎管狭窄症。结果随访4~9个月,腿痛VAS评分:术前(8.7±1.0)分,术后7 d(2.6±1.2)分,末次随访(2.0±1.0)分,手术前后差异有统计学意义(P<0.01)。根据Macnab疗效评定标准:优20例,良11例,可4例,优良率88.6%。结论采用系列环锯行经皮行椎间孔扩大成形是治疗腰椎管狭窄症简单,安全和有效的微创手术。     

椎间孔镜Ⅰ SEE技术治疗腰椎管狭窄合并腰椎间盘突出症——附10例患者

[目的]探讨椎间孔镜Ⅰ SEE技术治疗腰椎管狭窄合并腰椎间盘突出症的近期疗效。[方法]回顾性分析2017年1月~2017年3月于本院应用椎间孔镜Ⅰ SEE技术治疗并获得随访的10例腰椎管狭窄合并腰椎间盘突出症患者的临床资料,采用视觉模拟评分法(visual analogue scale/score,VAS)评估手术疗效,应用日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分对腰椎功能进行评估,并计算JOA改善率。[结果]手术时间60~110min,平均88 min;出血量5~20 ml,平均11.5 ml;住院时间3~7 d,平均5.4 d。所有患者随访3~6个月,平均4.5个月。术前VAS评分为(8.10±0.61)分,术后3 d VAS评分为(2.81±0.40)分,末次随访为(1.44±0.28)分。术前与术后3 d、末次随访比较差异有统计学意义(P0.05);术前JOA评分为(7.93±0.73)分,出院当天评分为(18.73±0.91)分,末次随访评分为(31.16±1.10)分,术前与出院时、末次随访比较差异有统计学意义(P0.05)。根据JOA评分标准计算改善率,优8例,良1例,可1例,差0例。[结论]应用椎间孔镜I see技术治疗腰椎管狭窄合并腰椎间盘突出症疗效确切,具有创伤小、手术时间短、恢复快、术后并发症少等优点。     

经皮椎间孔镜单侧入路双侧减压治疗椎间盘突出致腰椎管狭窄症的随机对照研究

正近年来随着微创设备的发展,经皮内镜减压治疗椎间盘突出和椎管狭窄均取得满意临床效果~([1])。本研究采用经皮椎间孔镜单侧入路双侧减压治疗椎间盘突出致腰椎管狭窄症,获得满意效果,现将结果报告如下。1资料与方法1.1一般资料选择2015-01-2016-09在我院就诊的腰椎间盘突出症所致腰椎管狭窄症患者106例作为研究对象。采用随机数字表法将患者分为对照组和观察组各53例,对照组53例中,     

可视化椎间孔镜技术与纤维内窥镜下椎间盘切除术治疗腰椎侧隐窝狭窄症的近期疗效比较

目的 :比较可视化椎间孔镜技术(可视化经皮经椎间孔内窥镜下椎间盘切除术,visualization of percutaneous transforaminal endoscopic discectomy,VPTED)与显微内窥镜下椎间盘切除术(microendoscopic discectomy,MED)治疗腰椎侧隐窝狭窄症的近期临床疗效。方法 :选取我院2016年3月~2017年3月收治的49例单节段腰椎侧隐窝狭窄合并腰椎间盘突出症患者,其中21例接受VPTED治疗,28例接受MED治疗,记录两组患者的手术切口长度、术中透视次数、手术时间、住院天数、住院费用;采用视觉模拟评分法(visual analogue scale/score,VAS)评估手术疗效,应用Oswestry功能指数(Oswestry disability index,ODI)评价临床疗效,末次随访行改良Mac Nab标准评估患者的疗效。结果:两组患者年龄、男女比例、随访时间、腰痛症状、肌力减退、感觉障碍及腱反射、突出节段(L3/4、L4/5、L5/S1)等一般情况无统计学差异(P0.05)。两组组内术后与术前VAS、ODI评分相比有统计学差异(P0.05),同时间点组间比较VAS、ODI评分无统计学差异(P0.05)。VPTED组手术切口长度(0.78±0.06cm)较MED组(1.95±0.12cm)小,手术时间(87.51±30.46min)较MED组(47.53±13.61min)长,透视次数(15.86±2.66)较MED组(2.18±0.38)多,差异有统计学意义(P0.05);两组住院时间及住院费用无明显差异(P0.05);末次随访改良Mac Nab标准评估疗效,VPTED组优17例,良3例,可1例,优良率为95.24%;MED组优22例,良4例,可2例,优良率为92.86%,两组优良率比较差异无统计学意义(P0.05)。结论 :可视化椎间孔镜技术与显微内窥镜下椎间盘切除术治疗腰椎侧隐窝狭窄症近期疗效良好,是一种安全、有效的微创手术方式。     

经皮椎间孔镜下椎间盘摘除术临床应用分析与技巧探讨

目的：研究经椎间孔镜下髓核摘除术(PELD)治疗腰椎间盘突出症的临床疗效,并发症分析及手术技巧。方法：选择2012年10月-2014年10月我院骨科收治重度腰椎间盘突出症患者共221例,分析对比术前,术后患者VAS及ODI评分,采用MacNab评分评定临床效果。结果：所有221例患者均顺利完成手术,手术时间50～85min,平均65min：出血量10-50ml,平均20ml,住院时间5－7天,其中197例患者术后随访12－20个月,平均14．7个月,术后3个月和1年时的VAS评分、ODI与术前相比有明显改善,有显著性改善(P<0．01),术后12个月评分相比术后3个月,评分亦有改善,均有显著性改善(P<0．05)。术后1年时MacNab评分优155例,良33例,差9例,优良率为94.4％。结论： 经皮椎间孔镜下椎间盘摘除术治疗腰椎间盘突出症具有创伤小,恢复快,疗效好,并发症低的优点,易得到患者接受,提高患者满意度,是今后脊柱外科医生必须掌握的一门技术。     

经皮椎间孔镜技术行腰椎间盘髓核摘除术的并发症以及原因分析

目的 探讨应用经皮椎间孔镜技术行腰椎间盘髓核摘除术的并发症发生原因,以期为临床防治提供理论依据和指导.方法 收集自2019年1月～2020年8月本院骨科收治的60例腰椎间盘突出症患者,均由同一团队施行经皮椎间孔镜下髓核摘除术.其中男性26例,女性34例;年龄25～83岁,平均(56.37±12.44)岁;所有患者均为单节段突出,统计并记录患者的术中并发症和术后并发症,并分析其原因.结果 患者术后1 d、1个月和3个月的VAS评分明显低于术前,差异有统计学意义(F=9.074,P<0.05).术中并发症包括皮肤贴膜进入术野1例,导丝断裂1例,硬脊膜撕裂1例,脑脊液渗漏2例和局麻药物过敏2例;术后并发症包括神经根水肿3例,血肿压迫神经根3例,髓核残留1例,椎间隙感染2例和足下垂1例.结论 利用经皮椎间孔镜技术行腰椎间盘髓核摘除术具有良好的应用前景;保持有良好的手术习惯,做好术前评估,注意手术细节,可很好地避免术中和术后并发症的发生.     

Thessys椎间孔镜技术治疗腰椎间盘突出症疗效分析

目的探讨经皮椎间孔镜技术治疗腰椎间盘突出症的疗效。方法对2011-05-2012-03期间的腰椎间盘突出症患者21例,采用视觉模拟评分法(VAS法)和改良Macnab疗效评定标准测评入院时和椎间孔镜术后(术后当时、术后一周、一月、三月及六月),评估经皮椎间孔镜技术(PTED)治疗腰椎间盘突出症的疗效和安全。结果术后当时、术后一周、一月、三月、六月VAS评分分别为(1.62±0.74)、(2.90±0.88)、(1.57±0.50)、(1.57±0.74)和(2.14±0.65)均显著低于术前的(8.71±0.84)(P值均<0.01),根据改良Macnab疗效评定优17例,良2例,可2例。术后优良率均为90.47%,3例老年患者于术后出现腰背肌肉痉挛,于腰大肌肌间沟神经阻滞后症状消失。结论椎间孔镜对腰椎间盘突出症近期疗效确切。     

经皮腰椎间孔镜手术的穿刺定位策略

目的探讨经皮腰椎间孔镜手术穿刺定位的策略。方法 2009年12月～2011年6月对218例下腰椎疾病行经皮腰椎间孔镜手术240次,根据患者的病史、临床表现及X线片等影像学资料,确定腰椎疾病的不同类型,术前制定定位麻醉计划,结合术中C形臂X线机定位,决定穿刺点及穿刺方向。结果 228例次(228/240,95.0%)一次穿刺成功,12例次(12/240,5.0%)重新定位穿刺。麻醉穿刺时间5～18 min,平均9.8 min。5例发生脑脊液漏:2例硬膜囊内镜下明显破裂、神经根损伤,术后并发患肢麻木无力,经保守治疗逐渐好转;3例硬膜囊无明显破裂,未特殊处理。2例发生手术椎间隙感染。2例穿刺过程中出现腹痛,经调整穿刺方向后症状减轻消失。218例术后随访4～18个月,平均13.5月,其中88例随访超过1年,术前功能障碍指数(Oswestry disability index,ODI)56.5±21.1,术后末次随访25.4±9.1,85.2%(75/88)的患者有改善;术前视觉模拟评分(visual analog score,VAS)为(6.9±3.1)分,术后末次随访为(2.8±2.2)分,88.6%(78/88)的患者有改善。结论椎间盘突出偏后外侧尤其是椎间孔附近、包容性椎间盘突出拟行髓核射频消融或纤维环成形者,穿刺角度与中央型突出穿刺路径区别对待;侧位观穿刺要紧贴上关节突边缘,针尖对准椎间盘中央。腰椎间孔狭窄、侧隐窝狭窄病人,若主要为椎体后缘增生钙化,路径稍向前平移,若主要由椎小关节增生引起,穿刺线向后平移。     

经皮椎间孔镜治疗腰椎管狭窄症效果分析

目的分析经皮椎间孔镜治疗腰椎管狭窄症的效果。方法回顾性分析2016-01-2017-10间在柘城县人民医院接受经皮椎间孔镜治疗的32例腰椎管狭窄症患者的临床资料。结果本组未发生神经根损伤、硬膜撕裂、椎间隙及椎管内感染和椎旁血肿形成等并发症。全部患者术后均获12个月随访,其间仅发生下肢深静脉血栓形成1例,经对症处理后好转。末次随访,患者的VAS评分及ODI指数均较术前明显改善,差异有统计学意义(P<0.05)。结论经皮椎间孔镜治疗腰椎管狭窄症,创伤小、术后疼痛缓解效果满意,安全性高,明显提升了患者的生活质量。     

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。     

经皮椎间孔镜治疗不同年龄段腰椎间盘突出症的短期疗效对比

目的 分析比较经皮椎间孔镜间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗不同年龄段腰椎间盘突出症(lumbar disc herniation,LDH)的短期疗效.方法 2018年1月至8月,前瞻性纳入需行PELD治疗的107例LDH病人,以年龄为依据分组...     

经皮钬激光治疗腰椎间盘突出症

目的：报告经皮钬激光治疗腰椎间盘突出症的临床效果。方法：自１９９４年６月～１９９５年６月，应用美国科以人公司生产的钬激光机经皮治疗腰椎间盘突出症２６例。其中男１９例，女７例，平均年龄３８岁。Ｌ４－５突出１５例，Ｌ５Ｓ１突出１１例。手术时局麻，后正中线旁８～１０ｃｍ处进针，进针方向与躯干矢状面成４５°角，透视下确认位置。钬激光汽化烧灼髓核组织，有效地降低了椎间盘内的压力，使突出的椎间盘组织回缩，解除了对神经根的压迫。结果：经１～２年随访，优良率８８％。结论：钬激光波长２．１μｍ，作用深度仅０．０４ｃｍ，采用脉冲式发射，具有极高的准确性和安全性。作者认为这是一种安全、有效的方法。     

经皮椎间孔镜腰椎间盘摘除术与微创经椎间孔腰椎融合术治疗腰椎间盘突出症的前瞻性随机对照研究

目的比较经皮椎间孔镜腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)与Quadrant通道辅助微创经椎间孔腰椎融合术(minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF)治疗腰椎间盘突出症的临床效果。方法 2010年1月~2013年12月,选择经保守治疗无效的腰椎间盘突出症60例,按随机数字表中随机数的奇数和偶数分为2组,每组30例。2组年龄、性别、病变节段、临床诊断、影像学检查差异无统计学意义(P0.05),由同一组脊柱外科医师手术,分别行PELD(TESSYS椎间孔镜系统)和Quadrant通道辅助Mis-TLIF。随访12~24个月,平均16.2月,比较2组手术时间、术中出血量、住院时间、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、JOA评分、改良Mac Nab标准评定,以及并发症的种类和发生率。结果与Mis-TLIF组相比,PELD组的手术时间短[(72.0±18.7)min vs.(137.0±48.3)min,t=-6.857,P=0.000],术中出血少[(28.0±14.7)ml vs.(314.0±13.6)ml,t=-11.831,P=0.000],住院时间短[(4.0±1.0)d vs.(10.0±3.0)d,t=-9.298,P=0.000]。术后2周和术后3个月PELD组腰腿痛的VAS评分优于Mis-TLIF组(P0.05)。术后3、12个月PELD组ODI、JOA评分明显优于Mis-TLIF组(P0.05)。2组术后12个月Mac Nab评级无统计学差异(P0.05)。2组并发症发生率差异无显著性。结论 PELD和Quadrant通道辅助Mis-TLIF治疗腰椎间盘突出症均可取得满意的临床疗效,前者切口小,手术时间短,出血少。     

Percutaneous Endoscopic Lumbar Discectomy Using a Double‐Cannula Guide Tube for Large Lumbar Disc Herniation

ObjectiveTo compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double‐cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to treat large lumbar disc herniations (LLDHs).MethodsSeventy patients who presented with LLDH without cauda equina syndrome and were treated with surgery in our hospital from October 2015 to October 2017 were included. The detailed index included the visual analog scale (VAS) for back and radicular leg pain and the Oswestry Disability Index (ODI) in the immediate preoperative period and at the final follow‐up. The operation time, radiation exposure time, surgical satisfaction rate, and modified MacNab criteria score were also recorded.ResultsThe leg and back pain of the patients in these groups improved significantly in the postoperative period. No significant differences were observed in leg pain improvement between the other two groups; however, patients in the PELD group (with or without DGT) presented with significantly higher improvement in back pain than the OLD group (t = 9.965, p < 0.001). The final ODI scores were 12.1 ± 4.9, 11.2 ± 2.9, and 16.4 ± 3.6 in the PELD, PELD‐DGT, and OLD groups, respectively. Patients in the PELD and PELD‐DGT groups presented with significantly lower postoperative ODI scores than those in the OLD group (t = 20.834, p < 0.001). The mean postoperative hospital stays were significantly shorter in the PELD group and PELD with DGT group than in the OLD group (t = 46.688, p < 0.001). The mean operation time was significantly shorter in the PELD‐DGT group than those in the PELD group (t = 25.281, p = 0.001). No perioperative complications were observed in either group. Based on the modified MacNab criteria, excellent and good outcomes were achieved in 20 out of 21 patients (95.2%) in the PELD group, 23 out of 24 patients (95.8%) in the PELD‐DGT group, and 22 out of 25 patients (88.0%) in the OLD group. The rates of excellent and good outcomes were higher in the PELD and PELD‐DGT groups than in the OLD group, but there were no significant differences (χ ² = 1.454, p = 0.835).ConclusionsPELD using DGT is a safe and effective option for LLDH and features advantages such as improvements in back pain, a lower hospitalization cost than OLD, a shorter operation time, and less fluoroscopy than traditional PELD.     

复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床疗效研究

目的:观察复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床疗效。方法:选取我院2017年6月—2020年12月收治的腰椎间盘突出症患者80例,按照随机数字表分为治疗组与对照组,每组40例。治疗组采用复元活血汤加减联合椎间孔镜手术治疗,对照组仅采用椎间孔镜手术治疗。记录并比较两组患者治疗前、术后1 d,术后2周、1个月、3个月的疼痛视觉模拟评分(VAS评分)、Oswestry功能指数(ODI评分)、JOA评分、足底红外热成像温差值。结果:术前、术后1 d、术后2周,两组患者腰腿疼痛VAS评分差异无统计学意义(P>0.05);术后1个月、术后3个月,治疗组腰腿疼痛VAS评分低于对照组,差异有统计学意义(P<0.05);患者术前、术后1 d,两组ODI评分差异无统计学意义(P>0.05);术后2周、术后1个月、3个月,治疗组ODI评分低于对照组,差异有统计学意义(P<0.00);术前、术后1 d,两组患者JOA评分差异无统计学意义(P>0.05);术后2周、术后1个月、3个月JOA评分,治疗组低于对照组,差异有统计学意义(P<0.05);术前、术后1 d、术后2周,两组患者足底红外温差差异无统计学意义(P>0.05);术后1个月、3个月,两组足底红外温差有统计学意义(P<0.05)。结论:复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床效果较好,术后肢体疼痛、功能恢复快,且并发症少。     

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope‐Assisted Tubular Discectomy for Lumbar Disc Herniation

ObjectiveThe aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope‐assisted tubular discectomy (MTD) for lumbar disc herniation (LDH).MethodsThis study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short‐Form 36 (SF‐36) and the EQ‐5D‐5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t‐tests. Multiple comparisons between samples were analyzed by analysis of variance.ResultsCompared with the MTD group, the PTED group had shorter incision length (9.20 ± 1.19 mm vs 26.38 ± 1.82 mm), less intraoperative blood loss (18.00 ± 4.97 mL vs 39.83 ± 6.51 mL), and shorter hospital stay (5.42 ± 5.08 days vs 10.58 ± 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 ± 1.00 vs 2.37 ± 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF‐36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ‐5D‐5L in the PTED group increased from 0.30 ± 0.17 before the operation to 0.69 ± 0.13 after 6 months of follow up (P = 0.00) and 0.73 ± 0.14 after 20 months of follow up. The EQ‐5D‐5L in the MTD group increased from 0.28 ± 0.17 before the operation to 0.68 ± 0.13 after a 6‐month follow up (P = 0.00), and 0.73 ± 0.12 after a 20‐month follow up.ConclusionAlthough both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.     

腰椎间盘突出症合并椎管狭窄23 例治疗分析

目的探讨经后路椎间盘镜手术治疗合并腰椎管狭窄症的椎间盘突出症的临床应用。方法采用后路椎间盘镜进行单侧开窗减压术。通过术前标记腰椎正侧位片定位，于定位棘突间隙后正中偏患侧作长约1.5 cm小切口，逐级扩张后置入工作通道管，钻除部分椎板，置入内窥镜，于电视监视器下显露椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织，彻底解除其对硬脊膜、神经根的压迫。结果本组共治疗合并腰椎管狭窄症的腰椎间盘突出症23例，平均随访7个月，按Prolo标准评定，治愈20例，有效2例，无效1例。结论本术式在严格掌握适应证前提下对合并腰椎管狭窄症的腰椎间盘突出症患者效果明显。     

Evaluation of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Disc Herniation: A Retrospective Study

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.     

A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study

ObjectiveTo compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside‐out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH).MethodA total of 135 patients with symptomatic LDH who were treated by inside‐out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved.ResultsThe VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow‐up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64–21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29–6.51, P = 0.025), pre‐ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41–14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow‐up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551).ConclusionThe PLL is recommended to be retained for inside‐out PETD surgery.