COMPARISON OF ENDOSCOPIC AND MICROSURGICAL METHODS IN THE TREATMENT OF LUMBAR DISC HERNIATIONS

ABSTRACT Objective: The development of minimally invasive spine surgery leads us to reflect on the efficiency of new methods compared with older ones. In the case of endoscopic spine surgery, we always seek to compare our results using new techniques with the results of older and trusted microsurgical techniques. Unfortunately, there are few reliable studies measuring endoscopic and microsurgical approaches. We therefore decided to compare our treatment results with those of what are, in our opinion, the best and most thorough studies found. Furthermore, we found no illustrated experience in the usability of endoscopic methods. We therefore analyzed each step of the technique used, according to the practical experience with microsurgical discectomy. Methods: We compared our two-year experience of treatment of 183 patients with lumbar disc herniations using the endoscopic technique, with data reported in the literature on microsurgical minimally invasive methods. Results: Our group achieved good to excellent results in 92.9% of cases (170 patients) compared to 90% reported in the literature. We compared the capabilities of endoscopic discectomy with microsurgical methods, and concluded that the endoscopic method is sufficient to perform any movement inside the surgical field that is microscopically possible. It is also possible to perform any type of spinal cord decompression, with better visualization provided by the endoscope. Conclusions: We conclude that endoscopic microdiscectomy is a good and reliable alternative, with better outcomes and more efficient usage of the approach space.

摘要

研究目的与背景：微创脊柱外科手术（minimally invasive spine surgery）的发展促使我们重新审视新型术式相较于传统术式的临床效率。以内镜脊柱手术（endoscopic spine surgery）为例，我们始终致力于将新型技术的治疗效果与成熟可靠的显微外科技术（microsurgical techniques）进行对标。遗憾的是，目前针对内镜与显微手术入路的高质量对照研究较为匮乏。因此，我们选取学界公认的最优且最全面的既往研究数据，与本中心的治疗结果开展对比分析。此外，我们尚未发现关于内镜术式临床应用的系统性图文经验总结，故结合显微椎间盘切除术（microsurgical discectomy）的实操经验，对本中心所采用的内镜术式各操作步骤进行了详尽分析。

研究方法：本研究对比了本中心2年间采用内镜技术治疗183例腰椎间盘突出症（lumbar disc herniations）患者的临床诊疗经验，与已发表文献中关于微创显微外科手术的相关数据。

研究结果：本中心组92.9%的病例（170例患者）获得了优良疗效，而文献报道的显微手术优良率为90%。我们将内镜下椎间盘切除术（endoscopic discectomy）与显微外科术式的操作能力进行对比后发现，内镜术式可完成显微手术所能实现的术野内所有操作，同时还可开展各类脊髓减压术（spinal cord decompression），且内镜提供的可视化效果更具优势。

研究结论：内镜下显微椎间盘切除术是一项可靠且优质的替代术式，其临床疗效更佳，术野空间利用效率更高。