侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛

Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty to treat discogenic low back pain

目的：观察侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛的疗效。方法：2007年4月～9月共收治经椎间盘造影证实的椎间盘源性腰痛患者25例，其中伴有下肢疼痛不适4例，术前腰痛VAS评分为6．24-0．97分，均采用侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗，术后1周、1个月、3个月、6个月和12个月时进行腰痛VAS评分，术后12个月时进行MaeNab评分。结果：2例于术后1周出现下肢“日光烧灼综合征”，均为L5/S1椎间盘纤维环破裂患者，经过脉冲电刺激治疗1周后缓解；无其他手术并发症发生。术前伴有下肢疼痛不适的4例患者术后下肢症状均缓解。随访12个月，术后1周腰痛VAS评分0．80±0．65分，术后1个月0．56±0．65分，术后3个月0．48±0．65分，术后6个月0．52±0．65分，术后12个月0．67±0．58分，术后各时间点评分较术前有明显降低（P〈0．01），术后6个月和12个月评分较术后1周无明显反弹（P〉0．05）。按照MacNab评分标准，12个月随访时优11例，良12例，可2例，总有效率100％，优良率92％。结论：侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术是治疗椎间盘源性腰痛的有效、微创方法。

Objective：To investigate the short-term outcome of posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty in the treatment of discogenic low back pain. Method：25 patients with discogenic low back pain confirmed by provocative pain test and discography were treated with posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty between April 2007 to September 2007 ,of these,there were 4 patients with sciatica.Preoperative VAS score of low back pain was 6.24±0.97.The VAS scores of 1 week,1 month,3 months,6 months and 12 months postoperative were recorded and the MacNab scores of 12 months postoperative were evaluated ether. Result： 2 cases with LS/S1 annular tears were found complicated with sun-burn syndrome,which were relieved by pulsed electro-stimulant therapy after 1 week.No other complications occurred.All the 4 cases complained of sciatica resolved postoperatively.All patients were followed-up for 12 months,VAS scores of 1 week,1 month, 3 months, 6 months and 12 months postoperative were 0.80±0.65,0.56±0.65,0.48±0.65,0.52±0.65 and 0.67±0.58 respectively,which decreased significantly compared with preoperative VAS scores （P〈0.01）.There was no significant difference with repect to VAS score among different postoperative time-point.There were 11 excellent,12 good,2 fair according to MacNab score system,with total effective rate up to 100% and rate of excellent and good up to 92%.Conclusion：Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty is an effective minimally invasive alternative for discogenic low back pain.