椎弓根上切迹磨削入路经皮椎间孔镜手术治疗腰椎骨性侧隐窝狭窄及高度游离椎间盘突出症

Treatment of lumbar vertebral lateral recess stenosis and highly migrated disc herniation by percutaneous transforaminal endoscopic discectomy through grinding upper medial notch of the pedicle

目的探讨椎弓根上切迹磨削入路经皮椎间孔镜手术治疗腰椎骨性侧隐窝狭窄及高度游离椎间盘突出症的临床疗效。方法回顾性分析自2017-01—2018-09采用椎弓根上切迹磨削入路椎间孔镜手术治疗的12例腰椎骨性侧隐窝狭窄(侧隐窝狭窄组)及15例高度游离椎间盘突出症(椎间盘高度游离组),比较2组术前、术后1 d、3、6、12个月腰痛VAS评分、腿痛VAS评分、ODI指数。结果 27例均顺利完成手术,随访时间平均10.2(9~12)个月。术中未出现神经根损伤及硬膜囊破裂等并发症。27例复查腰椎CT见骨性侧隐窝减压、游离间盘组织摘除彻底,术后自觉疼痛症状较术前有明显的缓解。2组术后术后1 d、3个月、6个月、12个月腰痛VAS评分、腿痛VAS评分、ODI评分较术前明显改善(P <0.05),末次随访时Macnab评分:优19例,良8例。结论椎弓根上切迹磨削入路椎间孔镜手术治疗腰椎骨性侧隐窝狭窄及高度游离椎间盘突出症安全有效,可明显缓解患者术后疼痛。

Objective To evaluate the clinical efficacy of the treatment of lumbar vertebral lateral recess stenosis and highly migrated disc herniation by percutaneous transforaminal endoscopic discectomy through grinding upper medial notch of the pedicle. Methods Twelve cases of lumbar vertebral lateral recess stenosis(lateral recess stenosis group) and fifteen cases of highly migrated disc herniation(highly migrated disc group) treated by percutaneous transforaminal endoscopic discectomy through grinding upper medial notch of the pedicle from January 2017 to September 2018 were analyzed retrospectively. The VAS and ODI scores of lumbar, leg pain were compared between the two groups before and 1 day, 3 months, 6 months and 12 months after operation. Results All 27 cases completed operation successfully, the average follow-up time was 10.2(9-12)months. There were no complications such as nerve root injury and dural sac rupture during the operation. And no serious complications occurred after the operation. In 27 cases, complete decompression of lateral recess and removal of free disc tissue were found by CT. The symptoms of postoperative sensory pain were significantly relieved compared with those before surgery,1 day, 3 months, 6 months and 12 months after operation, the VAS score of low back pain, VAS score of leg pain and ODI score of the two groups were significantly improved compared with those before operation(P <0.05). At the last follow-up, the Macnab score was excellent in 19 cases and good in 8 cases. Conclusion The surgery of percutaneous transforaminal endoscopic discectomy through grinding upper medial notch of the pedicle is safe and effective in treatment of lumbar vertebral lateral recess stenosis and highly migrated disc herniation, which can significantly relieve the postoperative pain of patients.