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.	尹德龍, 程鵬, 范震波, 等. 早期干預對腰椎間盤突出癥的影響——多中心大樣本量隨訪. 中國矯形外科雜志, 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, 鄭超, 伍驥, 等. 內窺鏡下椎間盤切除術治療腰椎間盤突出癥術后復發的影響因素分析. 中國脊柱脊髓雜志, 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.	張壯壯, 汪文龍, 劉正. 腰椎纖維環縫合技術的研究進展. 中國骨與關節雜志, 2020, 9(2): 153-156.
6.	劉俊良, 鎮萬新, 楊大志, 等. 經椎板間內鏡聯合纖維環縫合修復術治療巨大型腰5/骶1椎間盤突出癥的臨床療效分析. 廣州醫科大學學報, 2021, 49(3): 47-52.
7.	肖軍杰. 髓核摘除術結合纖維環縫合對腰椎間盤突出癥患者ODI、VAS評分的影響. 實用中西醫結合臨床, 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, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 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, 曹崢, 趙宏亮, 等. 全內鏡下腰椎纖維環縫合術的技術要點及臨床療效分析. 中國骨傷, 2020, 33(6): 498-504.
20.	朱召銀, 黎慶初, 楊洋, 等. 顯微內窺鏡下髓核摘除纖維環縫合治療腰椎間盤突出癥的療效分析. 中國脊柱脊髓雜志, 2017, 27(3): 213-219.
21.	李鵬飛, 趙宗茂, 賈楠, 等. 纖維環縫合對維持髓核摘除后椎間盤生物力學強度的影響. 中華實驗外科雜志, 2018, 35(2): 297-299.

1. 尹德龍, 程鵬, 范震波, 等. 早期干預對腰椎間盤突出癥的影響——多中心大樣本量隨訪. 中國矯形外科雜志, 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, 鄭超, 伍驥, 等. 內窺鏡下椎間盤切除術治療腰椎間盤突出癥術后復發的影響因素分析. 中國脊柱脊髓雜志, 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. 張壯壯, 汪文龍, 劉正. 腰椎纖維環縫合技術的研究進展. 中國骨與關節雜志, 2020, 9(2): 153-156.
6. 劉俊良, 鎮萬新, 楊大志, 等. 經椎板間內鏡聯合纖維環縫合修復術治療巨大型腰5/骶1椎間盤突出癥的臨床療效分析. 廣州醫科大學學報, 2021, 49(3): 47-52.
7. 肖軍杰. 髓核摘除術結合纖維環縫合對腰椎間盤突出癥患者ODI、VAS評分的影響. 實用中西醫結合臨床, 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, 田大勝, 陳磊, 等. 單邊雙通道內鏡技術在腰椎疾病中的應用研究進展. 中華骨科雜志, 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, 曹崢, 趙宏亮, 等. 全內鏡下腰椎纖維環縫合術的技術要點及臨床療效分析. 中國骨傷, 2020, 33(6): 498-504.
20. 朱召銀, 黎慶初, 楊洋, 等. 顯微內窺鏡下髓核摘除纖維環縫合治療腰椎間盤突出癥的療效分析. 中國脊柱脊髓雜志, 2017, 27(3): 213-219.
21. 李鵬飛, 趙宗茂, 賈楠, 等. 纖維環縫合對維持髓核摘除后椎間盤生物力學強度的影響. 中華實驗外科雜志, 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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