Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Chengyue ^1,2 , ZHANG Liangping ³ , CHENG Wei ¹ , WANG Dong ¹ , PAN Hao ¹ ,  ZHANG Wei ¹

1. Department of Orthopedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou Zhejiang, 310007, P. R. China;
2. Department of Orthopedics, Hangzhou Lin’an Traditional Chinese Medicine Hospital, Hangzhou Zhejiang, 311300, P. R. China;
3. Zhejiang Chinese Medical University, Hangzhou Zhejiang, 310053, P. R. China;

Corresponding author：

ZHANG Wei, Email: volcano8060@163.com

Keywords：

Unilateral biportal endoscopy technique; lumbar disc herniation; annulus fibrosus suture; minimally invasive spine surgery

DOI：

10.7507/1002-1892.202205095

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Objective To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH). Methods The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L_{4, 5} in 13 cases, and L₅, S₁ in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded. Results All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences (P<0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation (P<0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation (P>0.05). Conclusion UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.

Citation： ZHU Chengyue, ZHANG Liangping, CHENG Wei, WANG Dong, PAN Hao, ZHANG Wei. Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1186-1191. doi: 10.7507/1002-1892.202205095 Copy

1.	尹德龙, 程鹏, 范震波, 等. 早期干预对腰椎间盘突出症的影响——多中心大样本量随访. 中国矫形外科杂志, 2014, 22(13): 1153-1157.
2.	Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus, 2015, 39(4): E6. doi: 10.3171/2015.7.FOCUS15281.
3.	胡袒, 郑超, 伍骥, 等. 内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析. 中国脊柱脊髓杂志, 2015, 25(10): 899-903.
4.	Guardado AA, Baker A, Weightman A, et al. Lumbar intervertebral disc herniation: Annular closure devices and key design requirements. Bioengineering (Basel), 2022, 9(2): 47. doi: 10.3390/bioengineering9020047.
5.	张壮壮, 汪文龙, 刘正. 腰椎纤维环缝合技术的研究进展. 中国骨与关节杂志, 2020, 9(2): 153-156.
6.	刘俊良, 镇万新, 杨大志, 等. 经椎板间内镜联合纤维环缝合修复术治疗巨大型腰5/骶1椎间盘突出症的临床疗效分析. 广州医科大学学报, 2021, 49(3): 47-52.
7.	肖军杰. 髓核摘除术结合纤维环缝合对腰椎间盘突出症患者ODI、VAS评分的影响. 实用中西医结合临床, 2021, 21(3): 125-126.
8.	Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22. doi: 10.1186/s13018-018-0725-1.
9.	Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
10.	Heo DH, Park CK. Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus, 2019, 46(4): E18. doi: 10.3171/2019.1.FOCUS18695.
11.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
12.	Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
13.	Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
14.	Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
15.	朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
16.	Bailey A, Araghi A, Blumenthal S, et al. Prospective, multicenter, randomized, controlled study of anular repair in lumbar discectomy: two-year follow-up. Spine (Phila Pa 1976), 2013, 38(14): 1161-1169.
17.	Suh BG, Uh JH, Park SH, et al. Repair using conventional implant for ruptured annulus fibrosus after lumbar discectomy: surgical technique and case series. Asian Spine J, 2015, 9(1): 14-21.
18.	Parker SL, Grahovac G, Vukas D, et al. Effect of an annular closure device (barricaid) on same-level recurrent disk herniation and disk height loss after primary lumbar discectomy: Two-year results of a multicenter prospective cohort study. Clin Spine Surg, 2016, 29(10): 454-460.
19.	李振宙, 曹峥, 赵宏亮, 等. 全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析. 中国骨伤, 2020, 33(6): 498-504.
20.	朱召银, 黎庆初, 杨洋, 等. 显微内窥镜下髓核摘除纤维环缝合治疗腰椎间盘突出症的疗效分析. 中国脊柱脊髓杂志, 2017, 27(3): 213-219.
21.	李鹏飞, 赵宗茂, 贾楠, 等. 纤维环缝合对维持髓核摘除后椎间盘生物力学强度的影响. 中华实验外科杂志, 2018, 35(2): 297-299.

1. 尹德龙, 程鹏, 范震波, 等. 早期干预对腰椎间盘突出症的影响——多中心大样本量随访. 中国矫形外科杂志, 2014, 22(13): 1153-1157.
2. Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus, 2015, 39(4): E6. doi: 10.3171/2015.7.FOCUS15281.
3. 胡袒, 郑超, 伍骥, 等. 内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析. 中国脊柱脊髓杂志, 2015, 25(10): 899-903.
4. Guardado AA, Baker A, Weightman A, et al. Lumbar intervertebral disc herniation: Annular closure devices and key design requirements. Bioengineering (Basel), 2022, 9(2): 47. doi: 10.3390/bioengineering9020047.
5. 张壮壮, 汪文龙, 刘正. 腰椎纤维环缝合技术的研究进展. 中国骨与关节杂志, 2020, 9(2): 153-156.
6. 刘俊良, 镇万新, 杨大志, 等. 经椎板间内镜联合纤维环缝合修复术治疗巨大型腰5/骶1椎间盘突出症的临床疗效分析. 广州医科大学学报, 2021, 49(3): 47-52.
7. 肖军杰. 髓核摘除术结合纤维环缝合对腰椎间盘突出症患者ODI、VAS评分的影响. 实用中西医结合临床, 2021, 21(3): 125-126.
8. Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22. doi: 10.1186/s13018-018-0725-1.
9. Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg, 2018, 120: e684-e689.
10. Heo DH, Park CK. Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus, 2019, 46(4): E18. doi: 10.3171/2019.1.FOCUS18695.
11. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
12. Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
13. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
14. Park JH, Jun SG, Jung JT, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy. Orthopedics, 2017, 40(5): e779-e783.
15. 朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
16. Bailey A, Araghi A, Blumenthal S, et al. Prospective, multicenter, randomized, controlled study of anular repair in lumbar discectomy: two-year follow-up. Spine (Phila Pa 1976), 2013, 38(14): 1161-1169.
17. Suh BG, Uh JH, Park SH, et al. Repair using conventional implant for ruptured annulus fibrosus after lumbar discectomy: surgical technique and case series. Asian Spine J, 2015, 9(1): 14-21.
18. Parker SL, Grahovac G, Vukas D, et al. Effect of an annular closure device (barricaid) on same-level recurrent disk herniation and disk height loss after primary lumbar discectomy: Two-year results of a multicenter prospective cohort study. Clin Spine Surg, 2016, 29(10): 454-460.
19. 李振宙, 曹峥, 赵宏亮, 等. 全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析. 中国骨伤, 2020, 33(6): 498-504.
20. 朱召银, 黎庆初, 杨洋, 等. 显微内窥镜下髓核摘除纤维环缝合治疗腰椎间盘突出症的疗效分析. 中国脊柱脊髓杂志, 2017, 27(3): 213-219.
21. 李鹏飞, 赵宗茂, 贾楠, 等. 纤维环缝合对维持髓核摘除后椎间盘生物力学强度的影响. 中华实验外科杂志, 2018, 35(2): 297-299.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation

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