完全内視鏡下腰椎椎間板摘出術（full-endoscopic lumbar discectomy：FELD）導入期における短期手術成績―顕微鏡下腰椎椎間板ヘルニア摘出術例との比較―

抄録

  Background : While microscopic lumbar disc herniation (LDH) surgery has been performed at our institution for >20 years, full-endoscopic lumbar discectomy (FELD) was introduced in 2019 to further minimize invasiveness. We aimed to analyze and compare short-term results of patients who first underwent FELD with those of patients who underwent microscopic LDH surgery during the same period.

  Methods : FELD was performed in 10 patients over an 18-month period (FELD group, male : female ratio, 6 : 4 ; mean age, 57.2 ± 13.3 years). Of the 10 patients, interlaminar and transforaminal approaches were adopted in five and five patients, respectively. During the same period, microscopic LDH surgery was performed in 19 patients (microdiscectomy group). Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS) scores, operation time, bleeding volume, complications, and recurrence of symptoms were investigated and compared between the groups.

  Results : In the FELD group, the preoperative VAS score was significantly lower than that in the microdiscectomy group as was the preoperative JOA score. There was a significant improvement in both groups in terms of the JOA and VAS scores postoperatively. No serious complications were observed, and no differences in operation times or recurrence rates were noted between the groups.

  Conclusions : Adequate short-term results were confirmed for the initial FELD group ; however, preoperative severity in the FELD group was milder than that in the microdiscectomy group. We intend to expand the adaptation of this surgery to include more severe cases through increasing the number of surgical cases and improving our surgical technique.