后路腰椎间盘镜治疗单节段腰椎间盘突出症的MRI改变

Postoperative magnetic resonance imaging in treatment of single-level lumbar disc herniation with microendoscopic discectomy

目的为证实MED治疗腰椎间盘突出是否属微创手术提供影像学依据。方法对接受椎间盘突出髓核摘除手术的54例单节段腰椎间盘突出症患者进行随访(其中MED组32例,Love组22例),行MRI扫描,部分患者做了增强扫描。在MRI上观察测量手术前后硬膜外压痕大小、椎间隙高度率、软骨终板退变及信号改变情况并观察硬膜外压痕的强化情况。结果54例患者术后硬膜外压痕较术前明显缩小,但术后1年和3年随访时比较差异无显著性(P>0.05)。椎间隙高度有随时间下降趋势;软骨终板继续退变;MED组14例强化,Love组9例强化。以上观察指标两组间比较差异均无显著性(P>0.05)。结论术后MRI检查未能提供MED术微创的影像学依据。

Objective To investigate the postoperative magnetic resonance imaging in the treatment of single-level lumbar disc herniation with microendoscopic discectomy. Methods 54 consecutive patients who underwent microendoscopic discectomy (32 patients) and Love's method (22 patients) for single-level lumbar disc herniation were studied with MRI. The indentation of the theca sac, the height of the intervertebral space, the signal intensity of the end-plate was assessed on magnetic resonance imaging obtained before surgery and 1-year, 3-year after surgery. And 27 patients (16 patients in MED group and 11 patients in Love's method group) underwent magnetic resonance imaging with contract enhancement using gadolinium-dithylenetriamine pentaacetic acid in 3-year after surgery. Results The height of the intervertebral space and the indentation of the theca sac and the signal intensity of the end-plate were significantly decreased after surgery, but there was no difference between 1-year and 3-year after surgery. Enhancement of the indentation of the theca sac was seen in 14 patients of MED group and 9 patients of Love's method group. All those parameters had no difference compared between the MED group and the Love's method group(P>0.05). Conclusions The magnetic resonance imaging failed to show that MED is less invasive with respect to the level of surgery.