Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Peng ,  KONG Qingquan , SONG Yueming

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

KONG Qingquan, Email: kongspine@126.com

Keywords：

Lumbar disc herniation; buttock pain; percutaneous endoscopic lumbar discectomy; minimally invasive technique

DOI：

10.7507/1002-1892.201712015

Video：

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ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L_{4, 5} in 15 cases and L₅, S₁ in 19 cases; 2 cases had lumbar disc herniation at both L_{4, 5} and L₅, S₁. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.

Citation： CAI Peng, KONG Qingquan, SONG Yueming. Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 673-677. doi: 10.7507/1002-1892.201712015 Copy

1.	Takahashi N, Yabuki S, Aoki Y, et al. Pathomechanisms of nerve root injury caused by disc herniation: an experimental study of mechanical compression and chemical irritation. Spine (Phila Pa 1976), 2003, 28(5): 435-441.
2.	Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am, 1991, 22(2): 181-187.
3.	Kim DS, Lee JK, Jang JW, et al. Clinical features and treatments of upper lumbar disc herniations. J Korean Neurosurg S, 2010, 48(2): 119-124.
4.	Wouda EJ, Leenstra S, Vanneste JA. Scrotal pain as the presenting symptom of lumbar disc herniation: a report of 2 cases. Spine (Phila Pa 1976), 2005, 30(2): E47-49.
5.	賀學軍, 易惠軍, 范友兵, 等. 以腰臀部疼痛為主的腰椎間盤突出癥. 頸腰痛雜志, 2010, 31(5): 327-329.
6.	曹家樹, 劉樂, 易志堅, 等. 腰椎間盤突出癥與下腹痛的關系4例分析. 中國矯形外科雜志, 2010, 18(17): 1496.
7.	Yukawa Y, Kato F, Kajino G, et al. Groin pain associated with lower lumbar disc herniation. Spine (Phila Pa 1976), 1997, 22(15): 1736-1740.
8.	Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
9.	Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
10.	Bartynski WS. Clinical, anatomic, and imaging correlation in spine-related pain: the essential elements. Tech Vasc Interv Radiol, 2009, 12(1): 2-10.
11.	王洪偉, 李長青, 周躍. 腰椎間盤突出癥疼痛發生機制的研究進展. 中國矯形外科雜志, 2011, 19(7): 568-571.
12.	Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int, 2008, 105(12): 214-219.
13.	McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med, 2012, 27(4): 261-274.
14.	胡建山, 施向春, 王開明. 腰椎間盤突出癥與臀肌張力減退診斷體征. 中國骨傷, 2001, 14(6): 361-362.
15.	桑錫光, 湯繼文, 陳允震. 以臀部癥狀為主的腰椎間盤突出癥 15 例臨床分析. 山東醫藥, 2003, 43(32): 40-41.
16.	Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976), 1983, 8(3): 286-293.
17.	Konno T, Aota Y, Kuniya H, et al. Anatomical etiology of "pseudo-sciatica" from superior cluneal nerve entrapment: a laboratory investigation. J Pain Res, 2017, 10: 2539-2545.
18.	Nakamura SI, Takahashi K, Takahashi Y, et al. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg (Br), 1996, 78(4): 606-612.
19.	Suseki K, Takahashi Y, Takahashi K, et al. Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain. J Bone Joint Surg (Br), 1998, 80(4): 737-742.
20.	石作為, 姚猛, 王巖松, 等. 間盤源性下腰痛發生機制的探討. 中國疼痛醫學雜志, 2007, 13(1): 32-35.
21.	Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain, 2009, 147(1-3): 17-19.
22.	王剛, 劉尚禮, 程志安, 等. 椎間盤切除術對腰椎間盤突出癥腰痛的影響. 中國矯形外科雜志, 2009, 17(1): 23-26.
23.	Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976), 2007, 32(16): 1735-1747.
24.	王建, 周躍, 李長青, 等. 經皮內鏡椎間盤切除術治療慢性椎間盤源性腰痛的初步研究. 中國修復重建外科雜志, 2009, 23(4): 400-403.
25.	Tsou PM, Alan YC, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J, 2004, 4(5): 564-573.
26.	Ahn Y, Lee SH. Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain. Acta Neurochir (Wien), 2010, 152(10): 1695-1702.

1. Takahashi N, Yabuki S, Aoki Y, et al. Pathomechanisms of nerve root injury caused by disc herniation: an experimental study of mechanical compression and chemical irritation. Spine (Phila Pa 1976), 2003, 28(5): 435-441.
2. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am, 1991, 22(2): 181-187.
3. Kim DS, Lee JK, Jang JW, et al. Clinical features and treatments of upper lumbar disc herniations. J Korean Neurosurg S, 2010, 48(2): 119-124.
4. Wouda EJ, Leenstra S, Vanneste JA. Scrotal pain as the presenting symptom of lumbar disc herniation: a report of 2 cases. Spine (Phila Pa 1976), 2005, 30(2): E47-49.
5. 賀學軍, 易惠軍, 范友兵, 等. 以腰臀部疼痛為主的腰椎間盤突出癥. 頸腰痛雜志, 2010, 31(5): 327-329.
6. 曹家樹, 劉樂, 易志堅, 等. 腰椎間盤突出癥與下腹痛的關系4例分析. 中國矯形外科雜志, 2010, 18(17): 1496.
7. Yukawa Y, Kato F, Kajino G, et al. Groin pain associated with lower lumbar disc herniation. Spine (Phila Pa 1976), 1997, 22(15): 1736-1740.
8. Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
9. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
10. Bartynski WS. Clinical, anatomic, and imaging correlation in spine-related pain: the essential elements. Tech Vasc Interv Radiol, 2009, 12(1): 2-10.
11. 王洪偉, 李長青, 周躍. 腰椎間盤突出癥疼痛發生機制的研究進展. 中國矯形外科雜志, 2011, 19(7): 568-571.
12. Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int, 2008, 105(12): 214-219.
13. McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med, 2012, 27(4): 261-274.
14. 胡建山, 施向春, 王開明. 腰椎間盤突出癥與臀肌張力減退診斷體征. 中國骨傷, 2001, 14(6): 361-362.
15. 桑錫光, 湯繼文, 陳允震. 以臀部癥狀為主的腰椎間盤突出癥 15 例臨床分析. 山東醫藥, 2003, 43(32): 40-41.
16. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976), 1983, 8(3): 286-293.
17. Konno T, Aota Y, Kuniya H, et al. Anatomical etiology of "pseudo-sciatica" from superior cluneal nerve entrapment: a laboratory investigation. J Pain Res, 2017, 10: 2539-2545.
18. Nakamura SI, Takahashi K, Takahashi Y, et al. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg (Br), 1996, 78(4): 606-612.
19. Suseki K, Takahashi Y, Takahashi K, et al. Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain. J Bone Joint Surg (Br), 1998, 80(4): 737-742.
20. 石作為, 姚猛, 王巖松, 等. 間盤源性下腰痛發生機制的探討. 中國疼痛醫學雜志, 2007, 13(1): 32-35.
21. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain, 2009, 147(1-3): 17-19.
22. 王剛, 劉尚禮, 程志安, 等. 椎間盤切除術對腰椎間盤突出癥腰痛的影響. 中國矯形外科雜志, 2009, 17(1): 23-26.
23. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976), 2007, 32(16): 1735-1747.
24. 王建, 周躍, 李長青, 等. 經皮內鏡椎間盤切除術治療慢性椎間盤源性腰痛的初步研究. 中國修復重建外科雜志, 2009, 23(4): 400-403.
25. Tsou PM, Alan YC, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J, 2004, 4(5): 564-573.
26. Ahn Y, Lee SH. Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain. Acta Neurochir (Wien), 2010, 152(10): 1695-1702.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation

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