Microendoscopic discectomy associated with annulus repair: comparison of early functional recovery of the lumbar spine

doi:10.3969/j.issn.2095-4344.2014.46.002

Abstract

Abstract:

BACKGROUND: Studies have shown that limited lumbar discectomy can harvest better clinical efficacy, but also face a higher risk of recurrence. In clinic, how to guarantee access to good effect, and meanwhile to reduce the probability of recurrent disc herniation? The annulus repair technology may be an effective way, but it is rarely reported.

OBJECTIVE: To investigate the early clinical effects of endoscopic lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation.

METHODS: Totally 224 patients with lumbar disc herniation who accepted discectomy surgery were selected from the Department of Spinal Surgery, the Third Affiliated Hospital of Southern Medical University from January 2011 to January 2013, including 56 cases of microendoscopic discectomy associated with annulus repair (repair group) and 168 cases of microendoscopic discectomy (control group). Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were recorded before and at 10 days, 3 months, 6 months, 12 months and 18 months after operation. Simultaneously, operative time, blood loss, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded.

RESULTS AND CONCLUSION: In the repair group, only 51 patients completed the follow-up, while all the patients in the control group completed the follow-up. There was no difference between the repair and control groups before and after surgery in the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain (P > 0.05), but at 10 days after surgery, the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were significantly decreased in the repair group (P < 0.05), and this trend continued until the 18th month after surgery. There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications. The recurrence rate was 9.5% in the control group and 3.9% in the repair group. 31.2% of relapsed patients in the control group received the second operation, while on patient in the repair group received reoperation. These findings indicate that microendoscopic discectomy associated with annulus repair can obtain remarkable early clinical results, and effectively reduce the recurrent rate and risk of secondary lumbar disc surgery, which is safe and reliable.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: tissue engineering, intervertebral disk, diskectomy

CLC Number:

R318

Li Chuan-jiang, Li Qing-chu, Wang Xiao-yong, Liu Ze-zheng, Yang Yang. Microendoscopic discectomy associated with annulus repair: comparison of early functional recovery of the lumbar spine [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(46): 7386-7390.

Figures/Tables 3

2.1 受试者数量分析共224例患者，修复组缝合失败2例，3例外地患者失访，对照组均获得随访，无中途退出及后期补充，最终进入结果分析共219例。 2.2 受试者基线分析随访时间在18-36个月，平均随访28个月，两组患者年龄、性别、手术节段均差异无显著性意义(P < 0.05)，见表1。 2.3 内镜下腰椎间盘摘除同步行纤维环修复早期临床疗效对比修复组与对照组在年龄结构、性别比例、手术节段构成比、术前及术后Oswestry功能障碍评分、术前及术后腰腿痛目测类比评分、随访时间均差异无显著性意义 (P > 0.05)。两组腿痛术前目测类比评分为(5.5±1.0)分，术后10 d腿痛目测类比评分为(2.2±0.6)分，差异有显著性意义(P < 0.05)，并持续到术后随访末期。见图2。术前Oswestry功能障碍评分为(67.2±29.1)%，术后 10 d Oswestry功能障碍评分为(16.3±8.5)%，差异有显著性意义(P < 0.05)，同样持续到随访末期。综上，两组间其他时间点术前、术后随访Oswestry功能障碍评分均无显著差异，但各组术前与术后相比差异有显著性意义(P < 0.05)，并持续到术后随访末期，表明术后患者症状改善明显，并持续到术后18个月。 2.4 内镜下腰椎间盘摘除同步行纤维环修复患者术中出血量、并发症及术后复发情况修复组手术时间高于对照组(P < 0.05)。两组术中出血量差异无显著性意义(P > 0.05)。两组均无硬膜囊撕裂、椎间隙感染、椎管内血肿形成等严重并发症。修复组出现2例术后复发，对照组有16例复发，差异无显著性意义(P > 0.05)。见表2。修复组术后复发病例经积极保守治疗后好转，未行再次手术治疗，对照组16例复发病例，其中有5例需接受再次手术，术后症状得到缓解，复发病例中再次手术率为31.2%。两组均无硬膜囊撕裂、椎间隙感染、椎管内血肿形成等严重并发症，术中出血量、术后复发率差异均无显著性意义(P > 0.05)。"

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