Thoracic endoscopic-assisted anterior-lateral decompression and fusion for lumbar disc herniation associated with vertebral osteochondrosis / 中华骨科杂志

ABSTRACT

Objective:To investigate the feasibility and clinical effects of thoracic endoscopic-assisted anterior-lateral decompression and fusion for thoracolumbar or upper lumbar disc herniation (LDH) associated with vertebral osteochondrosis (VO).Methods:From December 2017 to December 2019, 10 patients of thoracolumbar or upper LDH associated with VO were treated with thoracic endoscopic-assisted anterior-lateral decompression and fusion, including 6 men and 4 women, with an average 49.2 years old (range, 37 to 65 years old). The involved levels included T 12L 1 in 5 cases, L 1, 2 in 2 cases and L 2, 3 in 3 cases. There were 4 cases of simple thoracolumbar or upper LDH associated with VO and 6 cases of thoracolumbar or upper LDH associated with VO combined with ligamentum flavum hyperplasia and ossification or kyphosis (combined with posterior decompression and internal fixation or posterior correction surgery). The visual analogue scale (VAS), Oswestry disability index (ODI) and anterior and posterior height of intervertebral space were evaluated at follow-up. The clinical effects were evaluated according to the modified MacNab criteria. Results:The operation was performed successfully in all the patients. During the operation, the herniated disc and ossification were clearly exposed and completely removed, with the sufficient decompression of spinal cord, nerve root and dural sac. The operation duration was 115.4±23.8 minutes (range, 70 to 180 mins). Intraoperative bleed loss was 122.6±21.3 ml (range, 40 to 310 ml). The patients were followed up for averagely 21.6 months (range, 12 to 36 months). At the final follow-up, VAS score decreased from preoperative 7.2±1.9 to 1.8±1.1, and ODI decreased from preoperative 64.3%±13.9% to 16.3%±5.1% ( P<0.05). The anterior height of intervertebral space recovered from preoperative 7.8±1.5 mm to 11.9±2.3 mm, and the posterior height of intervertebral space recovered from preoperative 4.5±1.1 mm to 7.4±1.6 mm ( P<0.05). According to modified MacNab criteria, the results were excellent in 9 cases and good in 1 case. Conclusion:For thoracolumbar or upper LDH associated with VO, thoracic endoscopic-assisted anterior-lateral decompression and fusion provided clear vision of the surgical field, fully exposed and completely removed the herniated disc and ossification, which achieved satisfactory short-term results.