Austin C Kaidi, Joshua Zhang, Tejas Subramanian, Chad Simon, Eric Mai, Adin Ehrlich, Prerana Katiyar, Gregory Kazarian, Patawut Bovonratwet, Evan Sheha, James Dowdell, Sheeraz A Qureshi, Sravisht Iyer
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引用次数: 0
Abstract
Background: Far-lateral lumbar disk herniation (FLLDH) poses a surgical challenge given the difficulty in visualizing the pathology with traditional techniques. Endoscopic microdiscectomy is a novel technique for the treatment of FLLDH with decreased soft tissue disruption. Purposes: We sought to compare the efficacy of tubular versus endoscopic microdiscectomy for FLLDH. Methods: A retrospective cohort study was performed that included patients undergoing uniportal endoscopic or tubular decompression for FLLDH over a 5-year period. The primary outcome was patient-reported outcome measures (PROMs). Secondary outcomes included operative time, intraoperative radiation, length of stay (LOS), and reoperation/complication rates. Comparisons between non-paired continuous variables were done with a 2-tailed independent sample t-test. Categorical variables were compared with a χ2 or a Fisher exact test. Significance was assumed at P < .05. Results: We identified 135 patients, 64 having undergone endoscopic and 71 tubular microdiscectomy. There were no differences in operative times (67.7 vs 68.2 minutes) or LOS (945.5 vs 911.1 minutes). Endoscopic microdiscectomy was associated with increased total fluoroscopy time (105.92 vs 34.66 seconds) and intraoperative radiation dose (33.68 vs 19.12 mGy). Postoperatively, both groups had statistically significant improvements in all PROMs at early and late follow-up. There was no difference in the magnitude of improvement or the rate of postoperative complications/reoperations between the groups. Conclusion: This retrospective review found that endoscopic microdiscectomy and tubular decompression were effective techniques for the treatment of FLLDH, showing significant improvement in postoperative PROMs and no differences in postoperative complications. However, endoscopic microdiscectomy is associated with increased intraoperative radiation exposure.
背景:远外侧腰椎间盘突出症(FLLDH)是一个外科挑战,因为传统技术很难看到病理。内窥镜显微椎间盘切除术是一种治疗FLLDH的新技术,减少了软组织的破坏。目的:我们试图比较管状椎间盘切除术与内窥镜显微椎间盘切除术治疗FLLDH的疗效。方法:一项回顾性队列研究,包括5年内接受单门静脉内窥镜或小管减压治疗FLLDH的患者。主要终点是患者报告的结果测量(PROMs)。次要结果包括手术时间、术中放射、住院时间(LOS)和再手术/并发症发生率。非配对连续变量间的比较采用双尾独立样本t检验。分类变量比较采用χ2或Fisher精确检验。结果:我们确定了135例患者,64例接受了内窥镜手术,71例接受了管状显微椎间盘切除术。手术时间(67.7 vs 68.2分钟)和LOS (945.5 vs 911.1分钟)无差异。内镜下显微椎间盘切除术增加了全透视时间(105.92 vs 34.66秒)和术中辐射剂量(33.68 vs 19.12 mGy)。术后,两组在早期和晚期随访时,所有prom均有统计学显著改善。两组之间的改善程度和术后并发症/再手术率没有差异。结论:本回顾性研究发现,内镜下显微椎间盘切除术和管状减压是治疗FLLDH的有效技术,可显著改善术后PROMs,术后并发症无差异。然而,内窥镜显微椎间盘切除术与术中辐射暴露增加有关。
期刊介绍:
The HSS Journal is the Musculoskeletal Journal of Hospital for Special Surgery. The aim of the HSS Journal is to promote cutting edge research, clinical pathways, and state-of-the-art techniques that inform and facilitate the continuing education of the orthopaedic and musculoskeletal communities. HSS Journal publishes articles that offer contributions to the advancement of the knowledge of musculoskeletal diseases and encourages submission of manuscripts from all musculoskeletal disciplines.