SHORT-TERM EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC SPINE SURGERY FOR TREATMENT OF LUMBAR DISC HERNIATION WITH POSTERIOR RING APOPHYSIS SEPARATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZUOYunzhou ^1,2 ,  KONGQingquan ¹ , LIXiaolong ¹ , XULian ¹ , HUShuai ¹ , ZENGJiancheng ¹ , SONGYueming ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, the Second Wuhan Hospital of Integrated Traditional and Western Medicine;

Corresponding?author：

KONGQingquan, Email: kongspine@126.com

Keywords：

Lumbar disc herniation; Posterior ring apophysis separation; Percutaneous endoscopic spine surgery; Short-term effectiveness

DOI：

10.7507/1002-1892.20140293

Video：

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Objective To investigate the feasibil ity and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. Methods Between July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L_{4, 5} in 22 cases and at L₅, S₁ in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L₄ level in 9 cases and at L₅ level in 8 cases, at posterior superior edge at L₅ level in 13 cases and in S₁ level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. Results Accurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. Conclusion Percutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.

Citation： ZUOYunzhou, KONGQingquan, LIXiaolong, XULian, HUShuai, ZENGJiancheng, SONGYueming. SHORT-TERM EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC SPINE SURGERY FOR TREATMENT OF LUMBAR DISC HERNIATION WITH POSTERIOR RING APOPHYSIS SEPARATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1353-1357. doi: 10.7507/1002-1892.20140293 Copy

1.	黃民鋒, 李明, 陳鋒, 等.腰椎間盤突出并椎體后緣離斷癥的手術治療.中國脊柱脊髓雜志, 2007, 17(8):596-599.
2.	Akhaddar A, Belfquih H, Oukabli M, et al. Posterior ring apophysis separation combined with lumbar disc herniation in adults:a 10-year experience in the surgical management of 87 cases. J Neurosurg Spine, 2011, 14(4):475-483.
3.	Radcliff KE, Kepler CK, Jakoi A, et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J, 2013, 13(10):1339-1349.
4.	Marquardt G, Bruder M, Theuss S, et al. Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations:a single-center series. Eur Spine J, 2012, 21(4):660-665.
5.	俞杭平, 范順武, 楊惠林, 等.腰椎間盤突出合并椎體后緣離斷癥的治療.中華骨科雜志, 2006, 26(3):170-174.
6.	陳仲強, 黨耕町, 張鳳山.腰椎椎體后緣離斷癥.中華骨科雜志, 1996, 16(12):750-752.
7.	Bae JS, Rhee WT, Kim WJ, et al. Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation. J Korean Neurosurg Soc, 2013, 53(3):145-149.
8.	張福琳, 劉慶鵬.腰椎椎體后緣離斷癥.中國骨與關節損傷雜志, 2013, 28(7):699-700.
9.	范順武, 胡志軍, 方向前, 等.小切口與傳統開放術式行后路腰椎椎體間融合術對脊旁肌損傷的對比研究.中華骨科雜志, 2009, 29(11): 1000-1004.
10.	鈕心剛, 張紅梅, 嚴力生.小切口手術治療腰椎椎體后緣離斷癥.中國骨傷, 2008, 21(2):132-133.
11.	Miwa T, Sakaura H, Yamashita T, et al. Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion. Eur Spine J, 2013, 22(12):2864-2868.
12.	Choi KC, Kim JS, Ryu KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation:transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6):547-556.
13.	Yagi M, Okada E, Ninomiya K, et al. Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis. J Neurosurg Spine, 2009, 10(4): 293-299.
14.	Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop, 2013, 10(1):13-16.
15.	孫明舉, 張雷, 王艷輝, 等.腰椎后路椎間盤鏡治療腰椎椎體后緣離斷癥.中華創傷雜志, 2013, 29(12):1198-1200.
16.	Wu X, Ma W, Du H, et al. A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J, 2013, 22(3):475-488.
17.	Chang CH, Lee ZL, Chen WJ, et al. Clinical significance of ring apophysis fracture in adolescent lumbar disc herniation. Spine, 2008, 33(16): 1750-1754.
18.	何江濤, 陳檢文, 張志明, 等.腰骶椎椎體后緣離斷癥的手術治療.中國脊柱脊髓雜志, 2012, 22(5):423-427.
19.	袁振超, 黃保華, 黃民鋒, 等.顯微椎間盤鏡下精確減壓法治療椎體后緣離斷癥.中國內鏡雜志, 2013, 19(5):503-506.
20.	Shirado O, Yamazaki Y, Takeda N, et al. Lumbar disc herniation associated with separation of the ring apophysis:is removal of the detached apophyses mandatory to achieve satisfactory results? Clin Orthop Relat Res, 2005, (431):120-128.

1. 黃民鋒, 李明, 陳鋒, 等.腰椎間盤突出并椎體后緣離斷癥的手術治療.中國脊柱脊髓雜志, 2007, 17(8):596-599.
2. Akhaddar A, Belfquih H, Oukabli M, et al. Posterior ring apophysis separation combined with lumbar disc herniation in adults:a 10-year experience in the surgical management of 87 cases. J Neurosurg Spine, 2011, 14(4):475-483.
3. Radcliff KE, Kepler CK, Jakoi A, et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J, 2013, 13(10):1339-1349.
4. Marquardt G, Bruder M, Theuss S, et al. Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations:a single-center series. Eur Spine J, 2012, 21(4):660-665.
5. 俞杭平, 范順武, 楊惠林, 等.腰椎間盤突出合并椎體后緣離斷癥的治療.中華骨科雜志, 2006, 26(3):170-174.
6. 陳仲強, 黨耕町, 張鳳山.腰椎椎體后緣離斷癥.中華骨科雜志, 1996, 16(12):750-752.
7. Bae JS, Rhee WT, Kim WJ, et al. Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation. J Korean Neurosurg Soc, 2013, 53(3):145-149.
8. 張福琳, 劉慶鵬.腰椎椎體后緣離斷癥.中國骨與關節損傷雜志, 2013, 28(7):699-700.
9. 范順武, 胡志軍, 方向前, 等.小切口與傳統開放術式行后路腰椎椎體間融合術對脊旁肌損傷的對比研究.中華骨科雜志, 2009, 29(11): 1000-1004.
10. 鈕心剛, 張紅梅, 嚴力生.小切口手術治療腰椎椎體后緣離斷癥.中國骨傷, 2008, 21(2):132-133.
11. Miwa T, Sakaura H, Yamashita T, et al. Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion. Eur Spine J, 2013, 22(12):2864-2868.
12. Choi KC, Kim JS, Ryu KS, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation:transforaminal versus interlaminar approach. Pain Physician, 2013, 16(6):547-556.
13. Yagi M, Okada E, Ninomiya K, et al. Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis. J Neurosurg Spine, 2009, 10(4): 293-299.
14. Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop, 2013, 10(1):13-16.
15. 孫明舉, 張雷, 王艷輝, 等.腰椎后路椎間盤鏡治療腰椎椎體后緣離斷癥.中華創傷雜志, 2013, 29(12):1198-1200.
16. Wu X, Ma W, Du H, et al. A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation. Eur Spine J, 2013, 22(3):475-488.
17. Chang CH, Lee ZL, Chen WJ, et al. Clinical significance of ring apophysis fracture in adolescent lumbar disc herniation. Spine, 2008, 33(16): 1750-1754.
18. 何江濤, 陳檢文, 張志明, 等.腰骶椎椎體后緣離斷癥的手術治療.中國脊柱脊髓雜志, 2012, 22(5):423-427.
19. 袁振超, 黃保華, 黃民鋒, 等.顯微椎間盤鏡下精確減壓法治療椎體后緣離斷癥.中國內鏡雜志, 2013, 19(5):503-506.
20. Shirado O, Yamazaki Y, Takeda N, et al. Lumbar disc herniation associated with separation of the ring apophysis:is removal of the detached apophyses mandatory to achieve satisfactory results? Clin Orthop Relat Res, 2005, (431):120-128.

Chinese Journal of Reparative and Reconstructive Surgery

SHORT-TERM EFFECTIVENESS OF PERCUTANEOUS ENDOSCOPIC SPINE SURGERY FOR TREATMENT OF LUMBAR DISC HERNIATION WITH POSTERIOR RING APOPHYSIS SEPARATION

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