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.	黄民锋, 李明, 陈锋, 等.腰椎间盘突出并椎体后缘离断症的手术治疗.中国脊柱脊髓杂志, 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, 范顺武, 杨惠林, 等.腰椎间盘突出合并椎体后缘离断症的治疗.中华骨科杂志, 2006, 26(3):170-174.
6.	陈仲强, 党耕町, 张凤山.腰椎椎体后缘离断症.中华骨科杂志, 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.	张福琳, 刘庆鹏.腰椎椎体后缘离断症.中国骨与关节损伤杂志, 2013, 28(7):699-700.
9.	范顺武, 胡志军, 方向前, 等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究.中华骨科杂志, 2009, 29(11): 1000-1004.
10.	钮心刚, 张红梅, 严力生.小切口手术治疗腰椎椎体后缘离断症.中国骨伤, 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.	孙明举, 张雷, 王艳辉, 等.腰椎后路椎间盘镜治疗腰椎椎体后缘离断症.中华创伤杂志, 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.	何江涛, 陈检文, 张志明, 等.腰骶椎椎体后缘离断症的手术治疗.中国脊柱脊髓杂志, 2012, 22(5):423-427.
19.	袁振超, 黄保华, 黄民锋, 等.显微椎间盘镜下精确减压法治疗椎体后缘离断症.中国内镜杂志, 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. 黄民锋, 李明, 陈锋, 等.腰椎间盘突出并椎体后缘离断症的手术治疗.中国脊柱脊髓杂志, 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, 范顺武, 杨惠林, 等.腰椎间盘突出合并椎体后缘离断症的治疗.中华骨科杂志, 2006, 26(3):170-174.
6. 陈仲强, 党耕町, 张凤山.腰椎椎体后缘离断症.中华骨科杂志, 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. 张福琳, 刘庆鹏.腰椎椎体后缘离断症.中国骨与关节损伤杂志, 2013, 28(7):699-700.
9. 范顺武, 胡志军, 方向前, 等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究.中华骨科杂志, 2009, 29(11): 1000-1004.
10. 钮心刚, 张红梅, 严力生.小切口手术治疗腰椎椎体后缘离断症.中国骨伤, 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. 孙明举, 张雷, 王艳辉, 等.腰椎后路椎间盘镜治疗腰椎椎体后缘离断症.中华创伤杂志, 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. 何江涛, 陈检文, 张志明, 等.腰骶椎椎体后缘离断症的手术治疗.中国脊柱脊髓杂志, 2012, 22(5):423-427.
19. 袁振超, 黄保华, 黄民锋, 等.显微椎间盘镜下精确减压法治疗椎体后缘离断症.中国内镜杂志, 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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