内镜治疗中青年双节段腰椎间盘突出症患者的手术策略

doi:10.19723/j.issn.1671-167X.2021.04.019

Abstract

Abstract:

Objective: To investigate clinical efficacy and safety of single and double segmental percutaneous lumbar discectomy for young and middle-aged patients with double-segment disc herniation. Methods: Retrospective analysis was undertaken for 32 young and middle-aged patients with percutaneous endoscopic lumbar discectomy (PELD) in the treatment of double-segment lumbar disc herniation from January 2015 to October 2018 in Peking University First Hospital. In the study, 18 cases were treated with single-segment treatment and 14 cases with double-segment treatment. Visual analogue score (VAS) and oswestry disability index (ODI) assessment were used to compare clinical symptom outcomes before surgery, 3 months after surgery and at the last follow-up. Macnab criteria were used to assess the patients’ overall satisfaction after surgery. Imaging parameters included lumbar lordosis, intervertebral height at each segment and endplate angle of lesion segment on the X-ray. And Michigan State University(MSU) rating and Pfirrmann scoring system were used to evaluate the grade of disc herniation and disc degeneration respectively on magnetic resonance imaging (MRI). The perioperative parameters included the surgeon, anesthesia method, operation time, postoperative hospital stay, postoperative bracing time and perioperative complications. Results: The mean follow-up time was (26.78±10.64) months. There was no significant difference in the follow-up time and baseline information between the two groups(P>0.05). ODI scores 3 months post-operatively and at the last follow-up were lower in the double segment (P<0.05). The ODI improvement was also more significant in the double-segment group at the last follow-up (P<0.05). There was no significant difference in radiographic parameters at baseline (P>0.05). MSU scale for the primary segment was significantly lowered after both operations (P<0.05). MSU scale for secondary segment was significantly lowered in double segment group but not in single segment group. Other imaging parameters were similar between the two groups (P>0.05). The operation time of the single-segment group was significantly shorter than that of the double-segment group(P<0.001). No perioperative complications were found in either group, but three patients underwent secondary lumbar surgery during the postoperative follow-up period in the single-segment group. Conclusion: For young and middle-aged patients with double-segment disc herniation, this study suggests double-segment PELD may be more advantageous than single-segment PELD in terms of asuring clinical efficacy without increasing perioperative risks.

Key words: Minimally invasive surgery, Discectomy, Double segment, Lumbar disc herniation

CLC Number:

R681.5

YUE Lei,WANG Yue-tian,BAI Chun-bi,CHEN Hao,FU Hao-yong,YU Zheng-rong,LI Chun-de,SUN Hao-lin. Analysis of surgical strategy of percutaneous endoscopic lumbar discectomy in young and middle-aged double-segment patients with lumbar disc herniation[J].Journal of Peking University (Health Sciences), 2021, 53(4): 734-739.

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References 21

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Items	Single segment group (n=18)	Double segment group (n=14)	P
Baseline parameter
Age/years, M(Q1, Q3)	39.50 (30.00, 46.25)	30.50 (28.00, 37.50)	0.077
Gender, male/female	12/6	9/5	1.000
Follow-up time/days, M(Q1, Q3)	26.00 (18.50, 35.75)	27.00 (21.00, 34.25)	0.955
BMI /(kg/m²), M(Q1, Q3)	24.33 (22.08, 24.90)	24.28 (22.39, 29.00)	0.587
ASA score, M(Q1, Q3)	1.00 (1.00, 2.00)	1.00 (1.00, 2.00)	0.667
Drinking, yes/no	7/11	4/10	0.712
Smoking, yes/no	6/12	3/11	0.694
Perioperative parameter
Surgeon, yes/no	11/7	9/5	1.000
Anesthesia method, intraspinal anesthesia/local anesthesia	15/3	12/2	1.000
Operation time/min, M(Q1, Q3)	102.50 (78.50, 126.50)	150.00 (133.25, 167.00)	<0.001^*
Postoperative time in hospital/d, M(Q1, Q3)	1.00 (1.00, 2.00)	1.00 (1.00, 1.25)	0.808
Postoperative bracing time/months, M(Q1, Q3)	2.00 (1.00, 3.00)	2.00 (1.75, 3.00)	0.837

Items
Single segment group, M (Q1, Q3)	VAS	6.00 (4.00, 6.00)	2.00 (2.00, 2.50)	2.00 (0.00, 2.00)	-0.67 (-0.69, -0.46)	-0.71 (-1.00, -0.63)	<0.001^*	<0.001	0.020^*
Single segment group, M (Q1, Q3)	ODI	0.38 (0.18, 0.76)	0.11 (0.04, 0.23)	0.06 (0.02, 0.15)	-0.68 (-0.89, -0.44)	-0.86 (-0.93, -0.53)	<0.001^*	<0.001	0.007^*
Double segment group, M (Q1, Q3)	VAS	6.00 (4.00, 6.50)	2.00 (0.00, 2.00)	0.00 (0.00, 0.25)	-0.67 (-1.00, -0.63)	-1.00 (-1.00, -0.97)	0.001^*	0.001^*	0.014^*
Double segment group, M (Q1, Q3)	ODI	0.52 (0.33, 0.79)	0.09 (0.02, 0.19)	0.00 (0.00, 0.05)	-0.86 (-0.96, -0.54)	-1.00 (-1.00, -0.89)	0.001^*	0.001^*	0.013^*
P	VAS	0.722	0.071	0.059	0.091	0.099
P	ODI	0.338	0.398	0.041^*	0.267	0.025^*

Items		Single segment group (preoperative)	Double segment group (preoperative)	Single segment group (postoperative)	Double segment group (postoperative)	P1	P2	P3	P4
Lumbar lordosis		30.47 (24.14, 39.35)	31.90 (24.38,34.95)	30.04 (24.19, 39.35)	32.82 (26.05,44.05)	1.000	0.488	0.983	0.158
Lumbar lordosis changes^☆				4.18 (-2.31, 6.47)	2.75 (-2.43, 8.32)		0.925
Lesion segment endplate angle	Major	7.55 (4.06, 10.85)	4.51 (3.38, 5.96)	7.54 (4.82, 9.40)	6.16 (1.59, 7.87)	0.116	0.125	0.679	0.875
Lesion segment endplate angle	Minor	9.27 (6.80, 14.08)	6.18 (4.23, 11.51)	10.93 (9.22, 12.03)	8.31 (5.39, 12.41)	0.145	0.235	0.711	0.300
Lesion segment endplate angle changes^☆	Major			0.16 (-2.50, 2.23)	0.61 (-2.50, 2.23)		0.866
Lesion segment endplate angle changes^☆	Minor			2.35 (0.11, 4.73)	1.74 (-2.18, 5.28)		0.837
Intervertebral height of lesion segment	Major	1.50 (1.00, 2.00)	2.00 (1.00, 2.00)	1.00 (1.00, 1.00)	1.00 (1.00, 1.00)	0.319	0.896	0.008^*	0.021^*
Intervertebral height of lesion segment	Minor	1.50 (1.00, 2.00)	2.00 (1.00, 2.00)	1.00 (1.00, 1.00)	1.00 (1.00, 1.00)	0.512	0.613	0.014^*	0.005^*
Intervertebral height changes^☆	Major			0.05 (-1.29, 0.67)	0.04 (-1.34, 0.67)		0.896
Intervertebral height changes^☆	Minor			-0.37 (-1.12, 0.50)	-0.64 (-1.19, -.0.06)		0.639
Pfirrman grading	Major	4.00 (3.75, 4.00)	3.50 (3.00, 4.25)			0.837
Pfirrman grading	Minor	4.00 (3.00, 4.00)	3.50 (3.00, 4.00)			0.357
MSU grading	Major	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	1.50 (1.00, 2.00)	1.00 (1.00, 2.00)	0.955	0.319	0.003^*	0.012^*
MSU grading	Minor	1.00 (1.00, 2.00)	2.00 (1.00, 2.00)	1.00 (1.00, 1.00)	1.00 (1.00, 2.00)	0.319	0.587	0.102	0.025^*
MSU grading changes^☆	Major			-1.00 (-1.00, 0.00)	-1.00 (-2.00, 0.00)		0.512
MSU grading changes^☆	Minor			0.00 (-1.00, 0.00)	0.00 (-1.00, 0.00)		0.587

Analysis of surgical strategy of percutaneous endoscopic lumbar discectomy in young and middle-aged double-segment patients with lumbar disc herniation

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