PDF(Pubmed)
Abstract：
OBJECTIVE: Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium- to long-term follow-up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment.
METHODS: This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ2 tests.
RESULTS: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895).
CONCLUSIONS: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.
METHODS: This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ2 tests.
RESULTS: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895).
CONCLUSIONS: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.
摘要：
目标：目前，目前尚无针对腰椎间盘突出症(LDH)的具体类型选择经皮内镜下腰椎间盘切除术(PELD)或传统经椎间孔腰椎椎间融合术(TLIF)的既定指南.基于密歇根州立大学(MSU)分类系统，这项研究首次对两种手术方法进行了5年以上的中长期随访分析，旨在提供经验证据，以协助在LDH治疗手术前做出更明智的决定。
方法：这是一项回顾性研究，包括2016年1月1日至2018年12月31日在我院接受PELD或TLIF治疗的273例单水平LDH患者。详细指标包括术前和术后1天的视觉模拟评分（VAS）评分和Oswestry残疾指数（ODI），1周,1年,5年随访。并发症,复发，并记录术后5年改良的MacNab标准评分.统计方法包括独立样本t检验，重复测量方差分析(ANOVA)，和χ2检验。
结果：根据MSU分类分为七组，发现在4次术后随访中,VAS和ODI评分均有改善(p<0.001).PELD在减轻疼痛和改善3B分类中的ODI评分方面比TLIF表现出更好的结果，2B,和2C(p<0.05)。TLIF在2A中表现出优于PELD的一致优势，2AB,3A,和3AB分类(p<0.05)。PELD组术后5年内总复发率(11.05%)高于TLIF组(3.96%)。这些主要集中在2A，2AB,3A,和3AB类型。此外，PELD的优良率高于TLIF，但差异无统计学意义（χ2=1.0568，p=0.5895）。
结论：这项研究表明PELD和TLIF可以缓解LDH，但在不同的MSU分类下具有优势。MSU分类具有特定的指导意义，可以帮助选择PELD或TLIF的手术方式，以实现腰椎间盘突出症患者的最佳治疗效果。
方法：这是一项回顾性研究，包括2016年1月1日至2018年12月31日在我院接受PELD或TLIF治疗的273例单水平LDH患者。详细指标包括术前和术后1天的视觉模拟评分（VAS）评分和Oswestry残疾指数（ODI），1周,1年,5年随访。并发症,复发，并记录术后5年改良的MacNab标准评分.统计方法包括独立样本t检验，重复测量方差分析(ANOVA)，和χ2检验。
结果：根据MSU分类分为七组，发现在4次术后随访中,VAS和ODI评分均有改善(p<0.001).PELD在减轻疼痛和改善3B分类中的ODI评分方面比TLIF表现出更好的结果，2B,和2C(p<0.05)。TLIF在2A中表现出优于PELD的一致优势，2AB,3A,和3AB分类(p<0.05)。PELD组术后5年内总复发率(11.05%)高于TLIF组(3.96%)。这些主要集中在2A，2AB,3A,和3AB类型。此外，PELD的优良率高于TLIF，但差异无统计学意义（χ2=1.0568，p=0.5895）。
结论：这项研究表明PELD和TLIF可以缓解LDH，但在不同的MSU分类下具有优势。MSU分类具有特定的指导意义，可以帮助选择PELD或TLIF的手术方式，以实现腰椎间盘突出症患者的最佳治疗效果。
