The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach
The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach
复制标题
DOI：
10.1016/j.clineuro.2015.03.003
复制
发表时间：
2015-06-01
影响因子：
1.9
通讯作者：
Zhao, Hong-liang
中科院分区：
文献类型：
--
作者：
Li, Zhen-zhou;Hou, Shu-xun;Zhao, Hong-liang
目的：方法：2011年4月至2011年12月，对72例L5/S1椎管内非包容性椎间盘突出症患者行全内窥镜下经椎板间入路椎间盘切除术。根据椎间盘突出与S1神经根的关系将L5/S1椎间盘突出分为腋型、腹型和肩型。腋窝型选择腋窝入路，腹型和肩型选择肩入路。术后复查MRI，评价椎间盘突出物切除的完整性。在一定的术前和术后时间点记录下腰痛和坐骨神经痛的视觉模拟评分（VAS）和奥斯韦斯特里残疾指数（ODI）。MacNab评分在12个月的follow-up.Results：所有的手术都完成了没有转换到其他手术技术。手术时间20-80 min，平均45 min。仅1例复发采用显微内窥镜椎间盘切除术进行翻修。无神经损伤和感染并发症。术后各时间点ODI及腰痛、坐骨神经痛VAS评分均较术前明显降低（P < 0.05）。12个月随访，MacNab评分：优44例，良26例，可1例，差1例。结论：根据椎间盘脱出或游离的部位，选择腋路或肩路，全内窥镜椎板间入路L5/S1椎间盘切除术是一种安全、合理、有效的微创脊柱手术技术，近期临床效果良好。(C)2015 Elsevier B. V.版权所有。
Objective: To analyze the surgical strategy, safety and clinical outcome of full-endoscopic discectomy through interlaminar approach in the case of L5/S1 intervertebral disc excision.Methods: From April 2011 to December 2011,72 cases of intracanalicular non-contained disc herniations at L5/S1 level were treated with full-endoscopic discectomy through interlaminar approach. L5/S1 disc herniation was divided into three types according to position of herniated disc related to S1 nerve root: axilla type, ventral type and shoulder type. Axilla approach was selected for axilla type while shoulder approach was selected for ventral type and shoulder type. After operation, MRI was reexamined to evaluate the resection completeness of prolapsed disc material. Visual analog scales (VAS) of low back pain and sciatica, and Oswestry disability index (ODI) were recorded in certain preoperative and postoperative time points. MacNab scores were evaluated at the 12-month follow-up.Results: All operations were completed without conversion to other surgical techniques. Average operation time was 45 min (20-80 min). Only one reoccurrence was revised with microendoscopic discectomy. No nerve injury and infection were complicated. Postoperative ODI and VAS of low back pain and sciatica were significantly decreased in each time point (P < 0.05). MacNab scores of 12-month follow-up include 44 excellent, 26 good, 1 fair and 1 poor.Conclusion: With proper selection between axilla approach and shoulder approach according to the sites of prolapsed or sequestered disc materials, full-endoscopic L5/S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes. (C) 2015 Elsevier B.V. All rights reserved.