요추 추간판 탈출에 대한 경천추 경막외 내시경 레이져 감압술

Abstract

Objective Radiculopathic leg pain as well as lower back pain is common symptom of lumbar disc herniations regardless of history of lumbar surgery. Recently, for lumbar disc herniation, Trans-Sacral Epiduroscopic Laser Decompression (SELD) has been a minimally invasive procedure before surgery. Especially, this procedure is performed through a sacral hiatus instead of conventional lumbar surgical area. It is a relatively safe and effective method even in patients with severe previous surgical adhesion. We analyzed the surgical results of SELD for lumbar disc herniation with the comparison between the groups of history of spinal surgery. Material and Methods According to history of lumbar surgery, total 175 patients (89 of female and 86 of male) with lumbar disc herniations were divided into two groups: Non surgery group (Group A, n=98) and previous surgery group (recurent disc herniation, Group B, n=77). Lumbar disc herniation was diagnosed by MR images in patients with low back pain and radiculopathic leg pain. All were treated with Trans-Sacral Epiduroscopic Laser Decompression (SELD) under local anesthesia with light sedation. Clinical outcomes of SELD were evaluated by Visual Analogue Scale (VAS)score and Oswestry Disability Index (ODI). We analysed the surgical outcome comparing 2 groups statistically. Results In Group A, the postoperative mean VAS decreased to 2.43±1.23 from 7.35±0.82 and in group B, the postoperative mean VAS decreased from 3.01±1.75 to 8.02±0.91. After 6 month later, VAS was 3.20±2.02 in group A and 3.75±1.02 in group B. The postoperative mean ODI increased to 10.52±6.25 from 32.12±5.12 in group A and in Group B, the postoperative mean ODI increased from 33.04±5.82 to 0.92±6.82. After 6 month later, ODI was 14.92±8.58 in group A and 16.48±8.33 in group B. The outcome scores in both groups were significantly decreased as well, however slightly increased again after 6 months later, Conclusion The trans-Sacral Epiduroscopic Laser Decompression (SELD) could be a alternative minimal invasive procedure for lumbar disc herniation as well as recurrent disc heration. However, longterm follow-up study is needed to evaluate the SELD can replace the conventional surgery.