Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 HAOYingjie , LIUTao , YULei , MACaoyuan , LIUYawei , LIZhilei , ZHANGDi

Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;

Corresponding?author：

HAOYingjie, Email: 13526788956@126.com

Keywords：

Transforaminal endoscopic; Coflex interspinous process dynamic reconstruction system; lumbar disc herniation; minimally invasive technology; youth

DOI：

10.7507/1002-1892.201608062

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Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L_{4, 5} in 30 cases and L₅, S₁ in 22 cases. In 30 patients at L_{4, 5} level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L₅, S₁ level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L_{4, 5} level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L₅, S₁ level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L_{4, 5} level and 12-20 months (mean, 17 months) in patients at L₅, S₁ level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients (P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients (P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one (P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one (P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.

Citation： HAOYingjie, LIUTao, YULei, MACaoyuan, LIUYawei, LIZhilei, ZHANGDi. Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 191-196. doi: 10.7507/1002-1892.201608062 Copy

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2.	Wang H, Cheng J, Xiao H, et al. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg, 2013, 115(8): 1415-1419.
3.	歐裕福, 李榮祝, 韋建勛, 等. 椎間盤鏡術與傳統椎板間隙開窗術治療青少年腰椎間盤突出癥的比較研究. 中國矯形外科雜志, 2012, 20(1): 18-20.
4.	李大剛, 蘇培基, 陳世忠, 等. 經皮內窺鏡治療青壯年腰椎間盤突出癥臨床分析. 實用骨科雜志, 2014, 20(10): 931-933.
5.	李柱海, 曾建成, 宋躍明, 等. 經皮內鏡椎間孔入路微創治療復發性腰椎間盤突出癥療效分析. 中國修復重建外科雜志, 2015, 29(1): 43-47.
6.	呂宏, 孔金海, 鐘南哲, 等. 經椎間孔入路經皮內窺鏡下椎間盤切除術治療腰椎椎間盤突出癥. 脊柱外科雜志, 2015, 13(6): 373-376.
7.	Ruetten S, Komp M, Mark H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spinal (Phila Pa 1976), 2008, 33(9): 931-939.
8.	Parisini P, Di Silvestre M, Greggi T, et al. Lumbar disc excision in children and adolescents. Spine (Phila Pa 1976), 2001, 26(18): 1997-2000.
9.	Kuh SU, Kim YS, Cho YE, et al. Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis/microsurgical discectomy/PLIF with cages. Yonsei Med J, 2005, 46(1): 125-132.
10.	張峽, 周躍, 任先軍, 等. 青少年腰椎間盤突出癥的手術治療. 中國脊柱脊髓雜志, 2006, 18(7): 512-514.
11.	許德榮, 宋友東, 王海, 等. 我國青少年腰椎間盤突出癥的薈萃分析. 中華醫學雜志, 2013, 93(45): 3606-3609.
12.	溫冰濤, 張西峰, 王巖, 等. 經皮內窺鏡治療腰椎間盤突出癥的并發癥及其處理. 中華外科雜志, 2011, 49(12): 1091-1095.
13.	Kim MJ, Lee SH, Jung ES, et al. Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients: comparison with results of microscopic diskectomy. Surg Neurol, 2007, 68 (6): 623-631.
14.	李長青, 周躍, 王建, 等. 經皮椎間孔內窺鏡下靶向穿刺椎間盤切除術治療腰椎間盤突出癥.中國脊柱脊髓雜志, 2013, 23(3): 193-197.
15.	Park JS, Chor SE, Cho TK, et al. Recurrence rate after herniotomy only versus discectomy in lumbar disc herniation. Korean J Spine, 2013, 10(4): 227-231.
16.	Park SC, Yoon SH, Hong YP, et al. Minimum 2-year follow-up result of degenerative spinal stenosis treated with interspinous u (coflex). J Korean Neurosurg Soc, 2009, 46(4): 292-299.
17.	徐丁, 徐華梓, 陳一橫, 等. 單純髓核摘除術與髓核摘除輔助Coflex動態固定術治療腰椎間盤突出癥的療效對比研究. 中華外科雜志, 2013, 51(2): 147-151.
18.	徐丁, 陳一橫, 曾晗冰, 等. Coflex棘突間動態固定系統治療腰椎間盤突出癥的短期療效評價. 中華外科雜志, 2009, 47(18): 1379-1382.
19.	周洋, 徐華梓, 池永龍, 等. Coflex動態穩定裝置在L₅/S₁退變性疾病中的應用. 中國脊柱脊髓雜志, 2011, 21(8): 627-632.
20.	Bono CM, Vaccaro AR. Interspinous process devices in the lumbar spine. J Spinal Disord Tech, 2007, 20(3): 255-261.
21.	劉進, 劉浩, 李濤, 等. 單節段Coflex棘突間動力重建與后路360°植骨融合治療腰椎退變性疾病的對比研究. 中國修復重建外科雜志, 2011, 25(6): 693-698.
22.	Villarejo F, Carceller F, de la Riva AG, et al. Experience with coflex interspinous implant. Acta Neurochir Suppl, 2011, 108: 171-175.

1. ?邱貴興, 戴尅戎. 骨科手術學. 3版. 北京: 人民衛生出版社, 2005: 1353-1368.
2. Wang H, Cheng J, Xiao H, et al. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg, 2013, 115(8): 1415-1419.
3. 歐裕福, 李榮祝, 韋建勛, 等. 椎間盤鏡術與傳統椎板間隙開窗術治療青少年腰椎間盤突出癥的比較研究. 中國矯形外科雜志, 2012, 20(1): 18-20.
4. 李大剛, 蘇培基, 陳世忠, 等. 經皮內窺鏡治療青壯年腰椎間盤突出癥臨床分析. 實用骨科雜志, 2014, 20(10): 931-933.
5. 李柱海, 曾建成, 宋躍明, 等. 經皮內鏡椎間孔入路微創治療復發性腰椎間盤突出癥療效分析. 中國修復重建外科雜志, 2015, 29(1): 43-47.
6. 呂宏, 孔金海, 鐘南哲, 等. 經椎間孔入路經皮內窺鏡下椎間盤切除術治療腰椎椎間盤突出癥. 脊柱外科雜志, 2015, 13(6): 373-376.
7. Ruetten S, Komp M, Mark H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spinal (Phila Pa 1976), 2008, 33(9): 931-939.
8. Parisini P, Di Silvestre M, Greggi T, et al. Lumbar disc excision in children and adolescents. Spine (Phila Pa 1976), 2001, 26(18): 1997-2000.
9. Kuh SU, Kim YS, Cho YE, et al. Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis/microsurgical discectomy/PLIF with cages. Yonsei Med J, 2005, 46(1): 125-132.
10. 張峽, 周躍, 任先軍, 等. 青少年腰椎間盤突出癥的手術治療. 中國脊柱脊髓雜志, 2006, 18(7): 512-514.
11. 許德榮, 宋友東, 王海, 等. 我國青少年腰椎間盤突出癥的薈萃分析. 中華醫學雜志, 2013, 93(45): 3606-3609.
12. 溫冰濤, 張西峰, 王巖, 等. 經皮內窺鏡治療腰椎間盤突出癥的并發癥及其處理. 中華外科雜志, 2011, 49(12): 1091-1095.
13. Kim MJ, Lee SH, Jung ES, et al. Targeted percutaneous transforaminal endoscopic diskectomy in 295 patients: comparison with results of microscopic diskectomy. Surg Neurol, 2007, 68 (6): 623-631.
14. 李長青, 周躍, 王建, 等. 經皮椎間孔內窺鏡下靶向穿刺椎間盤切除術治療腰椎間盤突出癥.中國脊柱脊髓雜志, 2013, 23(3): 193-197.
15. Park JS, Chor SE, Cho TK, et al. Recurrence rate after herniotomy only versus discectomy in lumbar disc herniation. Korean J Spine, 2013, 10(4): 227-231.
16. Park SC, Yoon SH, Hong YP, et al. Minimum 2-year follow-up result of degenerative spinal stenosis treated with interspinous u (coflex). J Korean Neurosurg Soc, 2009, 46(4): 292-299.
17. 徐丁, 徐華梓, 陳一橫, 等. 單純髓核摘除術與髓核摘除輔助Coflex動態固定術治療腰椎間盤突出癥的療效對比研究. 中華外科雜志, 2013, 51(2): 147-151.
18. 徐丁, 陳一橫, 曾晗冰, 等. Coflex棘突間動態固定系統治療腰椎間盤突出癥的短期療效評價. 中華外科雜志, 2009, 47(18): 1379-1382.
19. 周洋, 徐華梓, 池永龍, 等. Coflex動態穩定裝置在L₅/S₁退變性疾病中的應用. 中國脊柱脊髓雜志, 2011, 21(8): 627-632.
20. Bono CM, Vaccaro AR. Interspinous process devices in the lumbar spine. J Spinal Disord Tech, 2007, 20(3): 255-261.
21. 劉進, 劉浩, 李濤, 等. 單節段Coflex棘突間動力重建與后路360°植骨融合治療腰椎退變性疾病的對比研究. 中國修復重建外科雜志, 2011, 25(6): 693-698.
22. Villarejo F, Carceller F, de la Riva AG, et al. Experience with coflex interspinous implant. Acta Neurochir Suppl, 2011, 108: 171-175.

Chinese Journal of Reparative and Reconstructive Surgery

Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation

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