TREATMENT OF LUMBAR HERNIAS BY ENDOSCOPIC NUCLEOPLASTY WITH RADIOFREQUENCY

ABSTRACT Objective: To evaluate the postoperative outcomes of minimally invasive technique for treating lumbar disc herniation in patients undergoing percutaneous endoscopic nucleoplasty with radiofrequency in the center of minimally invasive procedures Veracruz (CEMIVER) of the HRAEV.. Methods: A descriptive, comparative, ambispective and longitudinal study. The clinical records of patients who underwent herniated disc surgery were reviewed from March 2010 to March 2015. Inclusion criteria were individuals of both sexes, aged 18-65 years, with disc herniation diagnosis by MRI, evocative discography (pain) and clinical evaluation. The variables were analyzed by VAS, Oswestry disability index for functional assessment and Macnab criteria for modified retrospective cross clinical classification. Results: 161 patients were included, 81 female and 80 male, aged between 18 and 65 years with severe (83.8%) and moderate (16.2%) disability according to the Oswestry disability index; the total of excellent results was 83.8%, 9.5% were good, 4.8% were median and 1.9% were poor results, according to the Macnab criteria; the average time of surgery was 84 minutes per procedure, and the postoperative average bleeding was 65 ml. Of the total, 87.4% of the patients were on an outpatient basis and 7.6% had a short hospital stay.. Conclusion: It was found that percutaneous endoscopic nucleoplasty with radiofrequency technique is a procedure that offers great benefits for patients with lumbar disc herniation, including performing it under local anesthesia, with clear visualization of the surgical field, minimal pain, little bleeding, shorter operative time, does not cause instability of anatomical structures and has minimal rate of complications.

摘要
研究目的：评估经皮内镜下射频髓核成形术治疗腰椎间盘突出症的术后疗效，该术式由HRAEV下属韦拉克鲁斯微创中心（CEMIVER）开展。
研究方法：本研究为描述性、对比性、双向性及纵向性研究，回顾性分析2010年3月至2015年3月期间接受椎间盘突出症手术的患者临床病历。纳入标准为：男女患者均可，年龄18~65岁，经磁共振成像（Magnetic Resonance Imaging, MRI）确诊椎间盘突出、椎间盘造影诱痛试验阳性，且经临床评估符合手术指征。本研究采用视觉模拟评分法（Visual Analogue Scale, VAS）、Oswestry功能障碍指数（Oswestry Disability Index, ODI）进行功能评估，并采用Macnab标准（Macnab Criteria）进行改良回顾性交叉临床分类以分析相关变量。
研究结果：本研究共纳入161例患者，其中女性81例，男性80例，年龄区间为18~65岁；根据Oswestry功能障碍指数评估，重度功能障碍者占83.8%，中度功能障碍者占16.2%。依据Macnab标准，疗效评定为优者占83.8%，良者占9.5%，可者占4.8%，差者占1.9%。单例手术平均时长为84分钟，术后平均失血量为65ml。总患者中87.4%为门诊手术患者，7.6%需接受短期住院治疗。
研究结论：结果显示，经皮内镜下射频髓核成形术可为腰椎间盘突出症患者带来诸多获益：可在局部麻醉下开展，术野清晰，疼痛轻微、失血量少、手术时长更短，不会造成解剖结构不稳定，且并发症发生率极低。