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.	欧裕福, 李荣祝, 韦建勋, 等. 椎间盘镜术与传统椎板间隙开窗术治疗青少年腰椎间盘突出症的比较研究. 中国矫形外科杂志, 2012, 20(1): 18-20.
4.	李大刚, 苏培基, 陈世忠, 等. 经皮内窥镜治疗青壮年腰椎间盘突出症临床分析. 实用骨科杂志, 2014, 20(10): 931-933.
5.	李柱海, 曾建成, 宋跃明, 等. 经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症疗效分析. 中国修复重建外科杂志, 2015, 29(1): 43-47.
6.	吕宏, 孔金海, 钟南哲, 等. 经椎间孔入路经皮内窥镜下椎间盘切除术治疗腰椎椎间盘突出症. 脊柱外科杂志, 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.	张峡, 周跃, 任先军, 等. 青少年腰椎间盘突出症的手术治疗. 中国脊柱脊髓杂志, 2006, 18(7): 512-514.
11.	许德荣, 宋友东, 王海, 等. 我国青少年腰椎间盘突出症的荟萃分析. 中华医学杂志, 2013, 93(45): 3606-3609.
12.	温冰涛, 张西峰, 王岩, 等. 经皮内窥镜治疗腰椎间盘突出症的并发症及其处理. 中华外科杂志, 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.	李长青, 周跃, 王建, 等. 经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症.中国脊柱脊髓杂志, 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, 徐华梓, 陈一横, 等. 单纯髓核摘除术与髓核摘除辅助Coflex动态固定术治疗腰椎间盘突出症的疗效对比研究. 中华外科杂志, 2013, 51(2): 147-151.
18.	徐丁, 陈一横, 曾晗冰, 等. Coflex棘突间动态固定系统治疗腰椎间盘突出症的短期疗效评价. 中华外科杂志, 2009, 47(18): 1379-1382.
19.	周洋, 徐华梓, 池永龙, 等. Coflex动态稳定装置在L₅/S₁退变性疾病中的应用. 中国脊柱脊髓杂志, 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.	刘进, 刘浩, 李涛, 等. 单节段Coflex棘突间动力重建与后路360°植骨融合治疗腰椎退变性疾病的对比研究. 中国修复重建外科杂志, 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. 邱贵兴, 戴尅戎. 骨科手术学. 3版. 北京: 人民卫生出版社, 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. 欧裕福, 李荣祝, 韦建勋, 等. 椎间盘镜术与传统椎板间隙开窗术治疗青少年腰椎间盘突出症的比较研究. 中国矫形外科杂志, 2012, 20(1): 18-20.
4. 李大刚, 苏培基, 陈世忠, 等. 经皮内窥镜治疗青壮年腰椎间盘突出症临床分析. 实用骨科杂志, 2014, 20(10): 931-933.
5. 李柱海, 曾建成, 宋跃明, 等. 经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症疗效分析. 中国修复重建外科杂志, 2015, 29(1): 43-47.
6. 吕宏, 孔金海, 钟南哲, 等. 经椎间孔入路经皮内窥镜下椎间盘切除术治疗腰椎椎间盘突出症. 脊柱外科杂志, 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. 张峡, 周跃, 任先军, 等. 青少年腰椎间盘突出症的手术治疗. 中国脊柱脊髓杂志, 2006, 18(7): 512-514.
11. 许德荣, 宋友东, 王海, 等. 我国青少年腰椎间盘突出症的荟萃分析. 中华医学杂志, 2013, 93(45): 3606-3609.
12. 温冰涛, 张西峰, 王岩, 等. 经皮内窥镜治疗腰椎间盘突出症的并发症及其处理. 中华外科杂志, 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. 李长青, 周跃, 王建, 等. 经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症.中国脊柱脊髓杂志, 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, 徐华梓, 陈一横, 等. 单纯髓核摘除术与髓核摘除辅助Coflex动态固定术治疗腰椎间盘突出症的疗效对比研究. 中华外科杂志, 2013, 51(2): 147-151.
18. 徐丁, 陈一横, 曾晗冰, 等. Coflex棘突间动态固定系统治疗腰椎间盘突出症的短期疗效评价. 中华外科杂志, 2009, 47(18): 1379-1382.
19. 周洋, 徐华梓, 池永龙, 等. Coflex动态稳定装置在L₅/S₁退变性疾病中的应用. 中国脊柱脊髓杂志, 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. 刘进, 刘浩, 李涛, 等. 单节段Coflex棘突间动力重建与后路360°植骨融合治疗腰椎退变性疾病的对比研究. 中国修复重建外科杂志, 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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