Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy.
Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy.
复制标题
DOI：
10.2147/tcrm.s283652
复制
发表时间：
2020
影响因子：
2.8
通讯作者：
Yu Z
中科院分区：
文献类型：
--
作者：
Wang A;Yu Z
本研究的目的是比较经皮内镜下腰椎间盘切除术（PELD）和微创经椎间孔腰椎椎体间融合术（MIS-TLIF）对PELD术后复发性腰椎间盘突出症（rLDH）翻修手术的疗效。本研究对46例rLDH患者进行了回顾性评估。所有患者于2015年1月至2019年6月期间在北京大学第一医院接受了PELD，然后接受了PELD （n=24）或mist - lif （n=22）的翻修手术。比较两组患者的术前资料、围手术期情况、并发症、复发情况及临床结果。与MIS-TLIF组相比，PELD组手术时间明显缩短，术中出血明显减少，术后住院时间明显缩短，复发率明显增高（P<0.05）。两组的并发症发生率相当。两组患者在术后12个月的随访中均获得满意的临床结果。在翻修手术后一个月，PELD组的背痛视觉模拟评分（VAS）和Oswestry残疾指数（ODI）也明显降低，而在6个月和12个月的随访中没有发现差异。PELD和MIS-TLIF作为原发性PELD后rLDH的翻修手术是有效的。在手术时间、术中出血量和术后住院时间方面，PELD优于MIS-TLIF。然而，在两种手术入路之间做出决定时，必须考虑其较高的术后复发率，并应充分告知患者。
The purpose of this study was to compare the outcomes between percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the revision surgery for recurrent lumbar disc herniation (rLDH) after PELD surgery. A total of 46 patients with rLDH were retrospectively assessed in this study. All the patients had received a PELD in Peking University First Hospital between January 2015 and June 2019, before they underwent a revision surgery by either PELD (n=24) or MIS-TLIF (n=22). The preoperative data, perioperative conditions, complications, recurrence condition, and clinical outcomes of the patients were compared between the two groups. Compared to the MIS-TLIF group, the PELD group had significantly shorter operative time, less intraoperative hemorrhage, and shorter postoperative hospitalization, but higher recurrence rate (P<0.05). Complication rates were comparable between the two groups. Both groups had satisfactory clinical outcomes at a 12-month follow-up after the revision surgery. The PELD group also showed significantly lower visual analog scale (VAS) scores of back pain and Oswestry disability index (ODI) in one month after the revision surgery, whereas the difference was not detectable at six- and 12-month follow-ups. Both PELD and MIS-TLIF are effective as a revision surgery for rLDH after primary PELD. PELD is superior to MIS-TLIF in terms of operative time amount of intraoperative hemorrhage and postoperative hospitalization. However, its higher postoperative recurrence rate must be considered and patients should be well informed, when making a decision between the two surgical approaches.