透明全可视化工作通道辅助经椎板间入路脊柱内镜手术的临床疗效分析

doi:10.3969/j.issn.1006-5725.2025.12.013

Abstract

Abstract:

Objective An innovative transparent full-visualization working channel was developed to investigate the clinical efficacy of applying a transparent full-visualization working channel in percutaneous endoscopic interlaminar discectomy （PEID） for the treatment of lumbar disc herniation. Methods The medical records of 145 patients who underwent PEID for lumbar disc herniation from September 2023 to September 2024 were included. These patients were classified into two groups based on the use of a transparent full-visualization working channel or a metal working channel： 69 cases in the transparent channel group and 76 cases in the metal channel group. A comparative analysis was carried out between the two groups， evaluating differences in baseline characteristics， surgical performance indicators， the incidence of postoperative complications， and overall treatment outcomes. Results The operative time in the transparent channel group was shorter than that in the metal channel group， and the difference was statistically significant （P < 0.05）. Regarding the length of postoperative hospital stays and the frequency of intraoperative fluoroscopy， no significant differences were observed between the transparent and metal channel groups （P > 0.05）. In the transparent channel group， postoperative sensory abnormalities in the lower extremities occurred in one patient， while in the metal channel group， seven patients experienced such issues. Nevertheless， this difference in complication rates did not reach statistical significance （P > 0.05）. Similarly， no significant differences were detected in EMG electrophysiological alerts during the placement of the working channel and nerve exploration between the two groups （P > 0.05）. However， during intraoperative decompression， the transparent channel group had 8 fewer EMG alarms compared to the metal channel group's total of 29， and this difference was statistically significant （P < 0.05）. Conclusions The application of a transparent fully visualized working channel in the transforaminal approach for PEID can achieve the same clinical efficacy as a metal working channel. Moreover， it can significantly reduce nerve root irritation. The microscopic field of view of the transparent working channel is notably superior to that of the metal working channel. This enhanced visibility expands the field of view， facilitating effective nerve observation and protection， and ultimately increasing the safety of the surgical procedure.

Key words: lumbar disc herniation, percutaneous endoscopic transforaminal discectomy, working channel, minimally invasive

CLC Number:

R681.57

Weiran SHI,Ying HUANG,Maji SUN,Feng YUAN. Clinical efficacy analysis of transparent fully visualized working channel in percutaneous endoscopic interlaminar discectomy[J]. The Journal of Practical Medicine, 2025, 41(12): 1859-1866.

Figures/Tables 10

Fig.1

Tab.1

Fig.2

Fig.3

Fig.4

Tab.2

Tab.3

Tab.4

Tab.5

Tab. 6

References 38

1	JIANG H W， CHEN C D， ZHAN B S， et al. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation： A retrospective study［J］. J Orthop Surg Res，2022，17（1）：30. doi:10.1186/s13018-022-02929-5 doi: 10.1186/s13018-022-02929-5
2	YUAN C， WEN B， LIN H. Clinical Analysis of Minimally Invasive Percutaneous Treatment of Severe Lumbar Disc Herniation with UBE Two-Channel Endoscopy and Foraminal Single-Channel Endoscopy Technique［J］. Oxid Med Cell Longev，2022，2022：9264852. doi:10.1155/2022/9264852 doi: 10.1155/2022/9264852
3	KÖGL N， PETR O， LÖSCHER W， et al. Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery［J］. Dtsch Arztebl Int，2024，121（13）：440-448.
4	CHEN J， JING X， LI C， et al. Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach： A Systematic Review and Meta-Analysis［J］. World Neurosurg，2018，116：412-420.e412. doi:10.1016/j.wneu.2018.05.075 doi: 10.1016/j.wneu.2018.05.075
5	CHEN Z， ZHANG L， DONG J， et al. Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disk Herniation： Five-year Results of a Randomized Controlled Trial［J］. Spine （Phila Pa 1976），2023，48（2）：79-88. doi:10.1097/brs.0000000000004468 doi: 10.1097/brs.0000000000004468
6	廖烨晖，叶入裴，唐超，等. 双通道与单通道椎板间入路髓核摘除术治疗腰椎间盘突出症的临床疗效比较［J］. 华西医学，2024，39（10）：1543-1550.
7	CHOI K C， KIM J S， LEE D C， et al. Percutaneous endoscopic lumbar discectomy： Minimally invasive technique for multiple episodes of lumbar disc herniation［J］. BMC Musculoskelet Disord，2017，18（1）：329. doi:10.1186/s12891-017-1697-8 doi: 10.1186/s12891-017-1697-8
8	FAN N， YUAN S， DU P， et al. Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis［J］. BMC Musculoskelet Disord，2021，22（1）：1041. doi:10.1186/s12891-021-04940-z doi: 10.1186/s12891-021-04940-z
9	韩秀丰，路文超，赵学航. PETD与PEID治疗钙化型腰椎间盘突出症的疗效及并发症分析［J］. 颈腰痛杂志，2024，45（5）：972-976.
10	CHENG Y P， CHENG X K， WU H. A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation［J］. BMC Musculoskelet Disord，2022，23（1）：244. doi:10.1186/s12891-022-05186-z doi: 10.1186/s12891-022-05186-z
11	MA H， SHEN M， TANG Z， et al. Percutaneous endoscopic interlaminar discectomy for high-grade migrated lumbar disc herniation： Clinical efficacy and safety assessment［J］. Int Orthop，2024，48（9）：2455-2463. doi:10.1007/s00264-024-06246-w doi: 10.1007/s00264-024-06246-w
12	LI T， YANG G， ZHONG W， et al. Percutaneous endoscopic transforaminal vs. interlaminar discectomy for L5-S1 lumbar disc herniation： A retrospective propensity score matching study［J］. J Orthop Surg Res，2024，19（1）：64. doi:10.1186/s13018-024-04543-z doi: 10.1186/s13018-024-04543-z
13	ZHOU Z， NI HJ， ZHAO W， et al. Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two-Level Disc Herniation［J］. Orthop Surg，2021，13（3）：979-988. doi:10.1111/os.12862 doi: 10.1111/os.12862
14	HUANG H， YANG M， FU Z， et al. Predicting and analysing of the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation： development and validation based nomogram［J］. Eur Spine J，2024，33（3）：906-914. doi:10.1007/s00586-024-08141-9 doi: 10.1007/s00586-024-08141-9
15	GAO A， YANG H， ZHU L， et al. Comparison of Interlaminar and Transforaminal Approaches for Treatment of L（5） /S（1） Disc Herniation by Percutaneous Endoscopic Discectomy［J］. Orthop Surg，2021，13（1）：63-70. doi:10.1111/os.12831 doi: 10.1111/os.12831
16	HUANG H， HU H， LIN X， et al. Percutaneous endoscopic interlaminar discectomy via inner border of inferior pedicle approach for downmigrated disc herniation： A retrospective study［J］. J Orthop Surg Res，2022，17（1）：359. doi:10.1186/s13018-022-03245-8 doi: 10.1186/s13018-022-03245-8
17	LI W， LIU Y C， ZHENG C F， et al. Diagnosis of Compressed Nerve Root in Lumbar Disc Herniation Patients by Surface Electromyography［J］. Orthop Surg，2018，10（1）：47-55. doi:10.1111/os.12362 doi: 10.1111/os.12362
18	CHOI K C， SHIM H K， HWANG J S， et al. Comparison of Surgical Invasiveness Between Microdiscectomy and 3 Different Endoscopic Discectomy Techniques for Lumbar Disc Herniation［J］. World Neurosurg，2018，116：e750-e758. doi:10.1016/j.wneu.2018.05.085 doi: 10.1016/j.wneu.2018.05.085
19	王威威，连鸿凯. 经皮椎间孔镜技术对巨大型腰椎间盘突出症患者功能恢复、创伤程度的前瞻性研究［J］. 实用医学杂志，2021，37（5）：648-653. doi:10.3969/j.issn.1006-5725.2021.05.018 doi: 10.3969/j.issn.1006-5725.2021.05.018
20	李坚，李锦锦，何丽萍. 经皮椎间孔镜脊柱系统术治疗腰椎间盘突出症合并神经根管狭窄［J］. 中山大学学报（医学科学版），2023，44（2）：342-347.
21	LIU X， YUAN S， TIAN Y， et al. Comparison of percutaneous endoscopic transforaminal discectomy， microendoscopic discectomy， and microdiscectomy for symptomatic lumbar disc herniation： Minimum 2-year follow-up results［J］. J Neurosurg Spine，2018，28（3）：317-325. doi:10.3171/2017.6.spine172 doi: 10.3171/2017.6.spine172
22	韩铁鹏，虞攀峰，黄鹏. 经皮脊柱内镜对比椎间盘镜治疗腰椎间盘突出症疗效的荟萃分析［J］. 中国疼痛医学杂志，2023，29（6）：463-470.
23	赵晓东，邓立明，王建波，等. 椎间孔镜与椎间盘镜治疗腰椎间盘突出症5年疗效比较［J］. 中国微创外科杂志，2019，19（8）：684-687，701.
24	REN C， QIN R， LI Y， et al. Microendoscopic Discectomy Combined with Annular Suture Versus Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation： A Prospective Observational Study［J］. Pain Physician，2020，23（6）：E713-E721.
25	CHANG H， XU J， YANG D， et al. Comparison of full-endoscopic foraminoplasty and lumbar discectomy （FEFLD）， unilateral biportal endoscopic （UBE） discectomy， and microdiscectomy （MD） for symptomatic lumbar disc herniation［J］. Eur Spine J，2023，32（2）：542-554. doi:10.1007/s00586-022-07510-6 doi: 10.1007/s00586-022-07510-6
26	KIM S K， KANG S S， HONG Y H， et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy： A multicenter， retrospective analysis［J］. J Orthop Surg Res，2018，13（1）：22. doi:10.1186/s13018-018-0725-1 doi: 10.1186/s13018-018-0725-1
27	GU G， LIU T， GUO H， et al. Treatment of L5-S1 Floating Calcified Lumbar Disc Herniation with Percutaneous Endoscopic Interlaminar Discectomy［J］. Orthop Surg，2024，16（3）：620-627. doi:10.1111/os.14007 doi: 10.1111/os.14007
28	HAN J， TANG W， LI G， et al. Comparison of Percutaneous Endoscopic Transforaminal and Interlaminar Approaches in Treating Adjacent Segment Disease Following Lumbar Decompression Surgery： A Clinical Retrospective Study［J］. Pain Physician，2023，26（7）：E833-E842. doi:10.36076/ppj.2023.26.e833 doi: 10.36076/ppj.2023.26.e833
29	PAN M， LI Q， LI S， et al. Percutaneous Endoscopic Lumbar Discectomy： Indications and Complications［J］. Pain Physician，2020，23（1）：49-56.
30	CHENG L， CAI H， LIU Z， et al. Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation： Retrospective 3-Year Results from 321 Patients［J］. World Neurosurg，2020，141：e537-e544. doi:10.1016/j.wneu.2020.05.234 doi: 10.1016/j.wneu.2020.05.234
31	SOLIMAN H， FRIDLEY J， TELFEIAN A， et al. Minimally Invasive， Far Lateral Lumbar Microdiscectomy with Intraoperative Computed Tomography Navigational Assistance and Electrophysiological Monitoring［J］. World Neurosurg，2019，122：e1228-e1239. doi:10.1016/j.wneu.2018.11.020 doi: 10.1016/j.wneu.2018.11.020
32	WU T M， CHOI D J， CHANG W S， et al. Exploring Physical Lumbar Microvascular Geometry Through Endoscopy and Illustrations： Implications for Clinical Interpretation［J］. Global Spine J，2025，15（2）：969-980. doi:10.1177/21925682231218729 doi: 10.1177/21925682231218729
33	ZHOU S， A J， XU X， et al. Comparison of surgical invasiveness and hidden blood loss between unilateral double portal endoscopic lumbar disc extraction and percutaneous endoscopic interlaminar discectomy for lumbar spinal stenosis［J］. J Orthop Surg Res，2024，19（1）：778. doi:10.1186/s13018-024-05274-x doi: 10.1186/s13018-024-05274-x
34	KIYOSUE H， MATSUMARU Y， NIIMI Y， et al. Angiographic and Clinical Characteristics of Thoracolumbar Spinal Epidural and Dural Arteriovenous Fistulas［J］. Stroke，2017，48（12）：3215-3222. doi:10.1161/strokeaha.117.019131 doi: 10.1161/strokeaha.117.019131
35	SHLOBIN NA， RAZ E， SHAPIRO M， et al. Spinal neurovascular complications with anterior thoracolumbar spine surgery： A systematic review and review of thoracolumbar vascular anatomy［J］. Neurosurg Focus，2020，49（3）：E9. doi:10.3171/2020.6.focus20373 doi: 10.3171/2020.6.focus20373
36	WU T L， YUAN J H， JIA J Y， et al. Percutaneous Endoscopic Interlaminar Discectomy via Laminoplasty Technique for L（5） -S（1） Lumbar Disc Herniation with a Narrow Interlaminar Window［J］. Orthop Surg，2021，13（3）：825-832. doi:10.1111/os.12978 doi: 10.1111/os.12978
37	梁磊，段晓晓，刘兰涛. 两种内镜椎间盘切除术早期临床结果比较［J］. 中国矫形外科杂志，2023，31（22）：2099-2103.
38	ZHOU C， ZHANG G， PANCHAL R R， et al. Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy［J］. Pain Physician，2018，21（2）：E105-E112.

项目	透明通道组（n = 69）	金属通道组（n = 76）	χ²/t值	P值
性别构成比（男/女）/例	33/36	36/40	0.003	0.956
年龄/岁	52.3 ± 14.2	51.6 ± 13.7	0.302	0.763
BMI/（kg/m²）	25.6 ± 4.7	25.3 ± 3.5	0.439	0.662
病程/月	12.8 ± 4.9	13.4 ± 5.3	0.706	0.482
病变节段/例			0.829	0.363
L₄/L₅	37	35
L₅/S₁	32	41

组别	平均手术时间/min	住院时间/d	术中透视次数
透明通道组（n = 69）	65.4 ± 7.2	2.9 ± 1.3	6.5 ± 1.3
金属通道组（n = 76）	68.3 ± 8.1	3.1 ± 1.7	6.6 ± 1.6
t值	2.269	0.790	0.411
P值	0.025	0.431	0.682

组别	放置工作通道时	术中减压时	探查神经时
透明通道组（n = 69）	69	8	69
金属通道组（n = 76）	76	29	76
χ²值	-	13.427	-
P 值	-	< 0.001	-

项目	透明通道组（n = 69）	金属通道组（n = 76）	χ²值	P值
感觉异常	1	7	2.823	0.093
术后复发	1	2	0.007	0.932

项目	透明通道组（n = 69）	金属通道组（n = 76）	t值	P值
VAS
术前 VAS	7.6 ± 1.2	7.8 ± 1.4	0.919	0.359
术后1个月	2.6 ± 0.8	2.7 ± 1.1	0.621	0.536
术后3个月	2.0 ± 0.6	2.1 ± 0.7	0.803	0.424
术后6个月	1.6 ± 0.6	1.7 ± 0.5	1.094	0.276
末次随访	0.7 ± 0.4	0.8 ± 0.6	1.169	0.245
ODI
术前ODI	54.3 ± 9.0	55.6 ± 9.4	0.849	0.398
术后1个月	15.2 ± 5.4	15.8 ± 5.7	0.649	0.517
术后3个月	10.8 ± 2.9	11.1 ± 3.2	0.589	0.557
术后6个月	8.1 ± 2.5	8.5 ± 2.8	0.904	0.368
末次随访	6.7 ± 2.3	7.1 ± 2.7	0.955	0.341

Clinical efficacy analysis of transparent fully visualized working channel in percutaneous endoscopic interlaminar discectomy

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 10

References 38

Related Articles 15

Recommended Articles

Metrics

Comments

组别	差	可	良	优	优良率/%
透明通道组（n = 69）	0	9	48	12	86.9
金属通道组（n = 76）	0	13	47	16	82.9
Z值	0.122
P 值	0.903

[1]	Honglin LIU,Kai CHEN,Zibo GAO,Chengyu HUANG,Yongjin. LI. Research progress of intervertebral foramen shaping in transforaminal endoscopic lumbar discectomy via the intervertebral foramen approach [J]. The Journal of Practical Medicine, 2025, 41(8): 1123-1129.
[2]	Shijian LAN,Mingwang QIU,Xiaohui LI,Zhiyong FAN,Shan WU. Optimization of parameters and study of muscle⁃relaxing effects in the treatment of lumbar intervertebral disc herniation by stereotaxic oblique⁃pulling manipulation [J]. The Journal of Practical Medicine, 2025, 41(12): 1791-1799.
[3]	Fengtong LOU,Haijun WANG,Rui CAO,Guotong ZHAO,Yu. DING. The application value of lower limb exoskeleton robots in postoperative rehabilitation following minimally invasive surgery for cervical spondylotic myelopathy [J]. The Journal of Practical Medicine, 2025, 41(10): 1548-1554.
[4]	Shuanghao ZHANG,Jie TAO,Zehua CAI,Xuerong RAN,Sisi WEI,Jinfeng PAN,Jinguo ZHAI. A study of the current status of female pelvic floor dysfunction patients′ knowledge of minimally invasive laser treatment of the reproductive tract and their intention to make treatment decisions [J]. The Journal of Practical Medicine, 2025, 41(1): 126-133.
[5]	Linyu ZENG,Ziming CHEN,Junqing ZENG,Yi YAN,Daying ZHANG,Lili GU. Ultrasound measurement of sciatic nerve cross⁃sectional area in early outcome assessment after endoscopic surgery for unilateral lumbar disc herniation [J]. The Journal of Practical Medicine, 2025, 41(1): 35-40.
[6]	Zihuan WANG,Yisheng ZHANG,Xirong YU,Chujie MA,Yonghao MO,Yuanming ZHONG. Clinical observation of single incision intervertebral foramen in the treatment of double⁃segment lumbar spinal stenosis complicated with lumbar disc herniation [J]. The Journal of Practical Medicine, 2025, 41(1): 41-47.
[7]	Zhiwei SHI,Jianming WU,Yahui NIU,Chen GONG. Comparative study of percutaneous endoscopic treatment of L₅/S₁ disc herniation by two approaches [J]. The Journal of Practical Medicine, 2024, 40(6): 807-813.
[8]	Yi WANG,Bin XU,Yangdahao CHEN,Weixing XU,Hongfeng SHENG. The clinic effect of mini open endoscope assisted⁃ACDF for cervical spondylotic radiculopathy [J]. The Journal of Practical Medicine, 2024, 40(20): 2880-2887.
[9]	Jia YUAN,Wenfeng FENG,Yunxiang DOU,Xuanjun CHEN,Zhihong ZHANG. Effective of repeated peripheral magnetic stimulation treatment over patients with lumbar disc herniation was observed based on neuroelectrophysiological examination [J]. The Journal of Practical Medicine, 2024, 40(12): 1665-1670.
[10]	Deta CHEN,Xinhua ZHAN,Xiaoping SHENG,Wu RAO,Jingliang GU,Yan YU. Effect of percutaneous endoscopic foraminal discectomy on clinical outcome of L₅⁃S₁ lumbar disc herniation and influence of iliac crest height on clinical efficacy [J]. The Journal of Practical Medicine, 2024, 40(12): 1690-1695.
[11]	Guosong HAN,Li MA,Jialong QI,Ke ZHENG,Zhou DONG,Yonghong CHENG,Zhidong. ZHANG. Clinical efficacy of uniportal interlaminar endoscopy versus unilateral biportal endoscopy for the treatment of lumbar disc herniation [J]. The Journal of Practical Medicine, 2024, 40(11): 1542-1548.
[12]	SUN Wenxi , YANG Yifan# , LIN Rui, ZHAO Shuai, LIU Bingxin, WANG Hongshen, LI Yongjin, CHEN Bolai. . Application progress of orthopedic robotic assistance in cervical surgery [J]. The Journal of Practical Medicine, 2023, 39(9): 1179-1184.
[13]	Cheng LUO,Shengjie GUO,Zhiling ZHANG,Fangjian. ZHOU. Feasibility and safety analysis of domestic single-port robot system-assisted laparoscopic partial nephrectomy [J]. The Journal of Practical Medicine, 2023, 39(24): 3275-3280.
[14]	Xiuquan QI,Wei WANG,Xiaokang QIU,Ye. XU. Establishment of Nomogram prediction model for latent blood loss in patients with lumbar disc herniation after operation [J]. The Journal of Practical Medicine, 2023, 39(18): 2300-2305.
[15]	LI Junjie, TANG Lanlan, YANG Zhenyuan, DENG Qiang, ZHANG Yanjun, LIU Yandong. . Application of iRobot II of orthopedic robotic system in percutaneous endoscopic nucleus pulposectomy [J]. The Journal of Practical Medicine, 2023, 39(12): 1564-1570.