经皮椎间孔镜技术治疗后路腰椎椎体间融合术后症状性邻近节段退变的疗效分析

目的 探讨经皮椎间孔镜技术治疗后路腰椎椎体间融合（PLIF）术后症状性邻近节段退变（ASD）的临床疗效。方法 回顾性分析湖北医药学院附属国药东风总医院自2019年9月至2021年9月采用经皮椎间孔镜技术治疗的16例既往行PLIF术后邻近节段退变的患者资料。比较术前与术后1、3、6、12个月的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），并在术后12个月随访采用改良MacNab标准评估临床疗效。结果 纳入标准的手术患者16例，平均随访时间（12.9±1.4）个月，所有手术顺利完成。与术前比较，术后1、3、6、12个月患者的疼痛VAS评分、ODI指数显著下降，差异均有统计学意义（P＜0.05）；术后6、12个月疼痛VAS评分、ODI指数均低于术后1个月，差异均有统计学意义（P＜0.05）。术后12个月采用改良MacNab标准评估临床疗效，其中优10例，良4例，可2例，差0例，优良率为87.5%。结论 经皮椎间孔镜技术治疗PLIF术后邻近节段退变疗效确切，减轻患者疼痛症状，具有创伤小、早期恢复快等优点，是治疗症状性ASD的有效手术方案。

Percutaneous transforaminal endoscopic discectomy technique for treatment of symptomatic adjacent segment degeneration after posterior lumbar interbody fusion

Objective To investigate the clinical efficacy of percutaneous transforaminal endoscopic discectomy technique for symptomatic adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF).Methods We retrospectively analyzed 16 patients with adjacent segment degeneration after previous PLIF treated with percutaneous transforaminal endoscopic discectomy technique from September 2019 to September 2021 at Sinopharm Dongfeng General Hospital, Hubei University of Medicine, and compared the pain visual analog score (VAS) and Oswestry disability index (ODI) before and 1, 3, 6, and 12 months after surgery, and assessed the clinical efficacy using modified MacNab criteria at the 12th month postoperative follow-up.Results Sixteen patients underwent standard surgery with a mean follow-up of (12.9±1.4) months. All procedures were successfully completed. The VAS, ODI of patients at 1, 3, 6, and 12 months after surgery were significantly decreased compared with those before surgery, and the differences were statistically significant (P<0.05); the VAS and ODI at 6 and 12 months after surgery were lower than those at 1 month after surgery, and the differences were statistically significant (P<0.05). Twelve months after surgery, the clinical efficacy was assessed by modified MacNab criteria, of which 10 cases were excellent, 4 cases were good, 2 cases were acceptable and 0 cases were poor, and the excellent and good rate was 87.5%.Conclusion Percutaneous transforaminal endoscopic discectomy technique is an effective surgical option for the treatment of symptomatic ASD after PLIF because of its efficacy, alleviation patients'' painful symptoms, and its advantages of minimal trauma and rapid early recovery.