Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy
Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy
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DOI：
10.1007/s00586-010-1290-4
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发表时间：
2010-03-01
影响因子：
2.8
通讯作者：
Minoia, Leone
中科院分区：
文献类型：
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作者：
Teli, Marco;Lovi, Alessio;Minoia, Leone
现有的关于显微内窥镜腰椎间盘切除术的研究报告了与开放和显微椎间盘切除术相似的结局，但在并发症方面的结果相互矛盾。我们设计了一项随机对照试验，以研究这三种技术的不同结局和并发症的假设。240例年龄在18-65岁之间的后路腰椎间盘突出症患者，症状持续6周以上，保守治疗，随机分为显微内窥镜（组1）、显微（组2）或开放（组3）椎间盘切除术。排除标准为疼痛持续时间小于6周、马尾神经损伤、椎间孔或椎间孔外疝、椎管狭窄、恶性肿瘤、既往脊柱手术、脊柱畸形、并发感染和风湿性疾病。手术和随访均在同一家机构进行。一名生物医学研究人员独立收集和审查了这些数据。ODI、背部和腿部VAS和SF-36是术前、术后以及6个月、12个月和24个月随访时使用的结局指标。212/240例（91%）患者完成了24个月随访期。VAS背部和腿部、ODI和SF 36评分显示组内临床和统计学显著改善，在整个随访期间组间无显著差异。硬脊膜撕裂、根损伤和复发性疝在第1组中明显更常见。第2组和第3组的伤口感染相似，但不影响第1组的患者。第1组的总成本显著较高，第3组较低。总之，显微内镜、显微镜或开放技术腰椎间盘切除术后2年的结局指标相同，但显微内镜更可能发生严重并发症，费用更高。
Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 18-65 years affected by posterior lumbar disc herniation and symptoms lasting over 6 weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6 weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12- and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2 years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy.