Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations - Extraforaminal targeted fragmentectomy technique using working channel endoscope
Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations - Extraforaminal targeted fragmentectomy technique using working channel endoscope
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DOI：
10.1097/01.brs.0000252093.31632.54
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发表时间：
2007-01-15
期刊：
影响因子：
3
通讯作者：
Chae, Yu Sik
中科院分区：
文献类型：
--
作者：
Choi, Gun;Lee, Sang-Ho;Chae, Yu Sik
研究设计：对41例采用一种新技术在局部麻醉下经皮内镜椎间孔外入路切除软性腰椎椎间孔外椎间盘突出症（EFDH）的患者进行回顾性分析。
目的：描述一种用于切除软性EFDH的新型且更安全的经皮内镜技术，并依据由奥斯维斯残疾指数（ODI）改良的一种新的客观标准报告结果。
背景资料概述：EFDH通常发生于老年患者，且表现出非典型症状。其诊断和治疗仍存在争议，不同作者描述了使用显微镜的开放中线或椎旁入路，成功率各异。传统上认为经皮内镜技术不适合此类椎间盘突出症。
方法：41例软性EFDH患者采用新技术接受经皮内镜椎间盘切除术。在我们的技术中，与先前描述的内镜技术相比，皮肤进针点更靠内侧，进针角度更陡。这可能有助于避免出口神经根损伤并提高手术效果。根据与术前值相比ODI的百分比变化来分析结果。
结果：平均随访34.1个月。根性疼痛的平均视觉模拟评分（VAS）从8.6分改善至1.9分，平均ODI从66.3分改善至11.5分。总体而言，92%的患者取得满意疗效。2例患者因需后续开放手术而疗效不佳。
结论：采用“椎间孔外靶向碎核摘除术”技术的经皮内镜椎间盘切除术对于选定的软性EFDH患者是一种有效且安全的手术。
Study Design. A retrospective analysis of 41 patients operated for excision of soft lumbar extraforaminal disc herniation (EFDH) by percutaneous endoscopic extraforaminal approach under local anesthesia by a new technique.Objectives. To describe a new and safer percutaneous endoscopic technique for the removal of soft EFDH and report the results on the basis of a new objective criterion modified from Oswestry Disability Index (ODI).Summary of Background Data. EFDHs usually occur in older patients and present with atypical symptoms. Their diagnosis and treatment are still controversial, with various authors describing open midline or paraspinal approaches using the microscope with varying amounts of success. Percutaneous endoscopic techniques have traditionally been considered unsuitable for these herniations.Methods. Forty-one patients with a soft EFDH were subjected to percutaneous endoscopic discectomy with the new technique. In our technique, the skin entry point is medial and the angle of approach steeper as compared with the earlier described endoscopic techniques. This might help in avoiding exiting root injury and increasing the efficacy of the procedure. The results were analyzed on the basis of percentage change in ODI as compared with preoperative values.Results. Mean follow-up was 34.1 month. Mean VAS score for radicular pain improved from 8.6 to 1.9, and mean ODI improved from 66.3 to 11.5. Overall, 92% of patients experienced satisfactory outcome. Two patients had poor outcome due to the need for subsequent open surgery.Conclusion. Percutaneous endoscopic discectomy using the "extraforaminal targeted fragmentectomy" technique is an effective and safe procedure for the select group of patients with a soft EFDH.