46. 经皮内窥镜椎间盘切除术与开放椎间盘切除术的长期益处：降低脊柱融合的风险和来自现实世界全球协作网络的患者亚组的见解

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100740

Sung Huang Laurent Tsai MD , Mohamad Bydon MD

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引用次数: 0

摘要

背景：经皮内镜腰椎间盘切除术（PELD）和开放式腰椎间盘切除术（OLD）治疗腰椎间盘突出症（LDH）的选择仍然存在争议。虽然这两种技术的短期效果相当，但它们的长期效果，特别是关于脊柱融合的进展，尚未得到充分探讨。本研究评估了PELD与OLD相关的后续脊柱融合的风险，并检查了患者人口统计学和合并症如何影响这些结果。目的：本研究评估PELD与OLD术后脊柱融合的长期风险，重点关注亚组特异性差异，包括年龄、种族、BMI和合并症。研究设计/设置：回顾性队列研究。患者样本：该研究包括来自TriNetX研究网络的123,405例诊断为腰椎间盘突出症（LDH）的患者。经纳入和排除标准：PELD组：93,853例PELD患者。OLD组：29,552例患者接受OLD。根据倾向评分匹配（1:1）来平衡基线特征，最终分析包括29,552对匹配对（总数：59,104例患者）。对这些患者进行长达20年的随访，以评估随后脊柱融合的风险。主要结果：后续脊柱融合术：定义为指椎间盘切除术（PELD或OLD）后进行的任何脊柱融合术。使用ICD-10-PCS和ICD-9程序代码（如0SG0070、81.00、81.04-81.08等）进行识别。次要结局：脊柱融合术的累积发生率：在20年随访期间使用Kaplan-Meier生存曲线进行分析。亚组结果：基于以下因素的脊柱融合风险分层分析：人口统计学：年龄（20-45岁，46-59岁，=60岁），性别，种族。生活方式因素：吸烟、酒精相关疾病。临床状况：合并症，如椎管狭窄，脊柱滑脱，缺血性心脏病，脊柱侧凸，慢性阻塞性肺病，慢性肾病，BMI =30 kg/m²。统计学意义：采用Cox比例风险模型计算脊柱融合术的风险比（HR），显著性阈值为p <；0.05.方法使用TriNetX研究网络，我们分析了2000年至2023年间诊断为LDH的123,405例患者的数据，其中包括93,853例PELD和29,552例OLD病例。倾向评分匹配后，创建1:1队列以确保基线可比性。对患者进行长达20年的随访，以评估后续脊柱融合的风险。Kaplan-Meier生存分析和Cox比例风险模型用于估计风险比（HR）和评估亚组结果。结果在20年的随访中，与OLD相比，speld显著降低了脊柱融合的风险(HR 0.706；95% ci: 0.656-0.760)。亚组分析显示，在年轻患者（20-45岁）、高bmi个体、白人和非裔美国人人群中均有一致的益处。然而，PELD在亚洲患者和酒精相关疾病患者中的有效性有限。从机制上讲，PELD对椎旁组织的保护和炎症的减少可以解释其在减少相邻节段退变和不稳定方面的长期优势。结论：speld在减少脊柱融合术的需要方面提供了大量的长期益处，特别是对于年轻、肥胖和种族不同的患者。这些发现支持PELD作为一种个性化的手术方法，可以最大限度地减少侵入性负担，同时优化结果。进一步的研究应探讨亚组特异性差异的潜在机制，并评估其他长期终点，包括功能恢复和生活质量。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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46. Long-term benefits of percutaneous endoscopic discectomy versus open discectomy: reduced risk of spinal fusion and insights across patient subgroups from the real world global collaborative network

BACKGROUND CONTEXT

The choice between percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for managing lumbar disc herniation (LDH) remains debated. While both techniques achieve comparable short-term outcomes, their long-term effects, particularly regarding the progression to spinal fusion, are underexplored. This study evaluates the risk of subsequent spinal fusion associated with PELD versus OLD and examines how patient demographics and comorbidities influence these outcomes.

PURPOSE

This study evaluates the long-term risk of spinal fusion following PELD versus OLD, with a focus on subgroup-specific differences, including age, race, BMI, and comorbidities.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

The study included 123,405 patients diagnosed with lumbar disc herniation (LDH) from the TriNetX Research Network. After applying inclusion and exclusion criteria: PELD Group: 93,853 patients undergoing PELD. OLD Group: 29,552 patients undergoing OLD. Following propensity score matching (1:1) to balance baseline characteristics, the final analysis included 29,552 matched pairs (total: 59,104 patients). These patients were followed for up to 20 years to assess the risk of subsequent spinal fusion.

OUTCOME MEASURES

Primary Outcome: Subsequent Spinal Fusion: Defined as any spinal fusion procedure performed after the index discectomy (PELD or OLD). Identified using ICD-10-PCS and ICD-9 procedure codes (eg, 0SG0070, 81.00, 81.04–81.08, etc.). Secondary Outcomes: Cumulative Incidence of Spinal Fusion: Analyzed using Kaplan-Meier survival curves over a 20-year follow-up period. Subgroup Outcomes: Stratified analysis of spinal fusion risk based on: Demographics: Age (20–45, 46–59, =60 years), gender, race. Lifestyle Factors: Smoking, alcohol-related disorders. Clinical Conditions: Comorbidities such as spinal stenosis, spondylolisthesis, ischemic heart disease, scoliosis, COPD, CKD, and BMI =30 kg/m². Statistical Significance: Hazard ratios (HR) for spinal fusion were calculated using Cox proportional hazards models, with a significance threshold of p < 0.05.

METHODS

Using the TriNetX Research Network, we analyzed data from 123,405 patients diagnosed with LDH between 2000 and 2023, including 93,853 PELD and 29,552 OLD cases. After propensity score matching, a 1:1 cohort was created to ensure baseline comparability. Patients were followed for up to 20 years to assess the risk of subsequent spinal fusion. Kaplan-Meier survival analyses and Cox proportional hazard models were employed to estimate hazard ratios (HR) and evaluate subgroup outcomes.

RESULTS

PELD significantly reduced the risk of spinal fusion compared to OLD over a 20-year follow-up (HR 0.706; 95% CI: 0.656–0.760). Subgroup analysis revealed consistent benefits across younger patients (20–45 years), high-BMI individuals, and White and African American populations. However, PELD demonstrated limited effectiveness in Asian patients and those with alcohol-related diseases. Mechanistically, PELD's preservation of paraspinal tissues and reduction of inflammation may explain its long-term advantages in minimizing adjacent segment degeneration and instability.

CONCLUSIONS

PELD offers substantial long-term benefits in reducing the need for spinal fusion, particularly for younger, obese, and racially diverse patients. These findings support PELD as a personalized surgical approach that minimizes invasive burden while optimizing outcomes. Further research should investigate mechanisms underlying subgroup-specific differences and evaluate additional long-term endpoints, including functional recovery and quality of life.