Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study.
背景 近年来，经皮椎间孔镜椎间盘切除术（PTED）已广泛应用于腰椎间盘突出症（LDH）的治疗；然而，通过传统单侧PTED入路实现双侧减压仍是一项关键挑战。本回顾性研究评估了因巨大中央型LDH导致腰椎狭窄并伴有双侧神经症状的患者接受单侧PTED治疗后的疗效。材料与方法 2018年1月至2020年12月，34例年龄22至54岁、患有巨大中央型LDH并伴有双侧神经症状的患者接受了单侧PTED治疗。采用视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及硬膜囊面积评估手术前后的临床疗效。在末次随访时，采用改良MacNab标准评估满意率。结果 术中出血量为81.56±14.72 mL（范围50-110）。手术时间为85.12±13.43 min（范围65-113）。住院时间为32.06±9.52 h（范围24-72）。随访时间为34.21±6.54个月（范围24-48）。术后各时间点腰痛及腿痛的VAS和ODI评分均显著改善（P<0.05）。基于改良MacNab标准的满意率为91.2%。1例患者发生脑脊液漏，1例患者出现术后症状复发。结论 本研究证实，单侧PTED在治疗巨大中央型LDH并伴有双侧神经症状时能够实现双侧减压，疗效安全可靠，可显著缓解腰痛和腿痛并改善肢体功能。
BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) has been widely applied for lumbar disc herniation (LDH) in recent years; however, the achievement of bilateral decompression through a conventional unilateral PTED approach remains a key challenge. This retrospective study evaluated outcomes after unilateral PTED among patients with lumbar stenosis due to a large central LDH and concomitant bilateral neurological symptoms. MATERIAL AND METHODS From January 2018 to December 2020, 34 patients aged 22 to 54 years with large central LDH and concomitant bilateral neurological symptoms received treatment via unilateral PTED. The visual analog scale (VAS), Oswestry Disability Index (ODI), and dural sac area were used to assess clinical efficacy before and after surgery. At the final follow-up, modified MacNab criteria were used to evaluate the satisfaction rate. RESULTS Intraoperative blood loss was 81.56±14.72 mL (range, 50-110). Operative time was 85.12±13.43 min (range, 65-113). Length of hospitalization was 32.06±9.52 h (range, 24-72). Follow-up duration was 34.21±6.54 months (range, 24-48). VAS and ODI scores for low back and leg pain significantly improved at all postoperative time points (P<0.05). The satisfaction rate, based on modified MacNab criteria, was 91.2%. Cerebrospinal fluid leakage occurred in 1 patient, and postoperative symptom recurrence occurred in 1 patient. CONCLUSIONS This study confirms that unilateral PTED can achieve bilateral decompression with safe and reliable outcomes in the treatment of large central LDH and concomitant bilateral neurological symptoms, substantially relieving low back and leg pain and improving limb function.
Yansheng Huang, Sibo Wang, Peng Zou, Shaoyan Shi. Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study.. Medical science monitor : international medical journal of experimental and clinical research. 2026; doi:10.12659/MSM.951022.
Yansheng Huang, Sibo Wang, Peng Zou, Shaoyan Shi (2026). Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study.. Medical science monitor : international medical journal of experimental and clinical research. https://doi.org/10.12659/MSM.951022
Yansheng Huang, Sibo Wang, Peng Zou, Shaoyan Shi. Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study.[J]. Medical science monitor : international medical journal of experimental and clinical research, 2026 doi:10.12659/MSM.951022.
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