Abstract：
OBJECTIVE: Foraminal and extraforaminal lumbar disc herniation (FELDH) is an important pathological condition that can lead to lumbar radiculopathy. The paraspinal muscle-splitting approach introduced by Reulen and Wiltse is a reasonable surgical technique. Minimally invasive procedures using a tubular retractor system have also been introduced. However, surgical treatment is considered more challenging for FELDH than for central or subarticular lumbar disc herniations (LDHs). Some researchers have proposed uniportal extraforaminal endoscopic lumbar discectomy through a posterolateral approach as an alternative for FELDH, but heterogeneous clinical results have been reported. Recently, the biportal endoscopic (BE) paraspinal approach has been suggested as an alternative. The aim of this study was to compare the clinical outcomes of BE and microscopic tubular (MT) paraspinal approaches for decompressive foraminotomy and lumbar discectomy (paraLD) in patients with FELDH.
METHODS: Ninety-one consecutive patients with unilateral lumbar radiculopathy and FELDH underwent paraLD. Demographic and perioperative data were collected. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI) for spinal disability, and the modified Macnab criteria for patient satisfaction. Postoperative complications and reoperation rates were also evaluated.
RESULTS: In total, 76 patients were included in the final analysis. Among them, 43 underwent BE paraLD (group A) and the remaining 33 underwent MT paraLD (group B). The demographic and preoperative data were not statistically different between the groups. All patients showed significant improvements in VAS back, VAS leg, and ODI scores compared with baseline values (p < 0.05). The improvement in VAS back scores was significantly better in group A than in group B on postoperative day 2 (p < 0.001). However, all clinical parameters were comparable between the two groups after postoperative year 1 (p > 0.05). According to the modified Macnab criteria, 86.1% and 72.7% of the patients had excellent or good outcomes in groups A and B, respectively. No intergroup differences were observed (p = 0.367). In addition, there were no differences in the total operation time or amount of surgical drainage. Postoperative complications were not significantly different between the two groups (p = 0.301); however, reoperation rates were significantly higher in group B (p = 0.035).
CONCLUSIONS: BE paraLD is an effective treatment for FELDH and is an alternative to MT paraLD. In particular, BE paraLD has advantages of early improvement in postoperative back pain and low reoperation rates.
METHODS: Ninety-one consecutive patients with unilateral lumbar radiculopathy and FELDH underwent paraLD. Demographic and perioperative data were collected. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI) for spinal disability, and the modified Macnab criteria for patient satisfaction. Postoperative complications and reoperation rates were also evaluated.
RESULTS: In total, 76 patients were included in the final analysis. Among them, 43 underwent BE paraLD (group A) and the remaining 33 underwent MT paraLD (group B). The demographic and preoperative data were not statistically different between the groups. All patients showed significant improvements in VAS back, VAS leg, and ODI scores compared with baseline values (p < 0.05). The improvement in VAS back scores was significantly better in group A than in group B on postoperative day 2 (p < 0.001). However, all clinical parameters were comparable between the two groups after postoperative year 1 (p > 0.05). According to the modified Macnab criteria, 86.1% and 72.7% of the patients had excellent or good outcomes in groups A and B, respectively. No intergroup differences were observed (p = 0.367). In addition, there were no differences in the total operation time or amount of surgical drainage. Postoperative complications were not significantly different between the two groups (p = 0.301); however, reoperation rates were significantly higher in group B (p = 0.035).
CONCLUSIONS: BE paraLD is an effective treatment for FELDH and is an alternative to MT paraLD. In particular, BE paraLD has advantages of early improvement in postoperative back pain and low reoperation rates.
摘要：
目的：椎间孔和椎间孔外腰椎间盘突出症（FELDH）是导致腰椎神经根病的重要病理条件。Reulen和Wiltse引入的椎旁肌肉分裂方法是一种合理的手术技术。还引入了使用管状牵开器系统的微创手术。然而,FELDH的手术治疗比中央或关节下腰椎间盘突出症（LDHs）更具挑战性。一些研究人员提出了通过后外侧入路单孔椎间孔外内窥镜腰椎间盘切除术作为FELDH的替代方法，但是已经报道了异质性的临床结果。最近,已建议将双门静脉内窥镜（BE）椎旁入路作为替代方法。这项研究的目的是比较BE和显微管状（MT）椎旁入路对FELDH患者进行减压椎间孔切开术和腰椎间盘切除术（paraLD）的临床效果。
方法：91例单侧腰椎神经根病和FELDH患者接受paraLD治疗。收集人口统计学和围手术期数据。使用视觉模拟量表（VAS）评估背部和腿部疼痛的临床结果。脊柱残疾的Oswestry残疾指数(ODI)，和改良的Macnab患者满意度标准。术后并发症和再手术率也进行了评估。
结果：总计，最终分析包括76例患者。其中,43例接受BEparaLD（A组），其余33例接受MTparaLD（B组）。两组之间的人口统计学和术前数据没有统计学差异。所有患者VAS背部均有显著改善，VAS支腿,和ODI评分与基线值相比(p<0.05)。术后第2天，A组的VAS背部评分改善明显优于B组（p<0.001）。然而,术后1年，两组患者的临床指标具有可比性（p>0.05）。根据修改后的Macnab标准,86.1%和72.7%的患者在A组和B组中有优异或良好的预后,分别。没有观察到组间差异(p=0.367)。此外,手术总时间或手术引流量无差异.术后并发症在两组间无显著差异(p=0.301);B组的再手术率明显高于对照组(p=0.035)。
结论：BEparaLD是FELDH的有效治疗方法，是MTparaLD的替代方法。特别是,BEparaLD具有早期改善术后背痛和低再手术率的优点。
方法：91例单侧腰椎神经根病和FELDH患者接受paraLD治疗。收集人口统计学和围手术期数据。使用视觉模拟量表（VAS）评估背部和腿部疼痛的临床结果。脊柱残疾的Oswestry残疾指数(ODI)，和改良的Macnab患者满意度标准。术后并发症和再手术率也进行了评估。
结果：总计，最终分析包括76例患者。其中,43例接受BEparaLD（A组），其余33例接受MTparaLD（B组）。两组之间的人口统计学和术前数据没有统计学差异。所有患者VAS背部均有显著改善，VAS支腿,和ODI评分与基线值相比(p<0.05)。术后第2天，A组的VAS背部评分改善明显优于B组（p<0.001）。然而,术后1年，两组患者的临床指标具有可比性（p>0.05）。根据修改后的Macnab标准,86.1%和72.7%的患者在A组和B组中有优异或良好的预后,分别。没有观察到组间差异(p=0.367)。此外,手术总时间或手术引流量无差异.术后并发症在两组间无显著差异(p=0.301);B组的再手术率明显高于对照组(p=0.035)。
结论：BEparaLD是FELDH的有效治疗方法，是MTparaLD的替代方法。特别是,BEparaLD具有早期改善术后背痛和低再手术率的优点。
