Full Percutaneous Lumbar Interbody Fusion: Technical Note
Full Percutaneous Lumbar Interbody Fusion: Technical Note
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DOI：
10.1055/s-0037-1604360
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发表时间：
2017-11-01
影响因子：
1
通讯作者：
Taguchi, Mitsuto
中科院分区：
文献类型：
--
作者：
Nakamura, Shu;Taguchi, Mitsuto
引言虽然腰椎椎间融合术对严重椎间盘退变引起的腰痛有效，但它是一种高度侵入性的手术。微创手术如经椎间孔腰椎椎间融合术（TLIF）和腰椎外侧椎间融合术已成为可能;然而，仍有改进的余地。我们进行了充分的经皮内窥镜腰椎椎间融合术（PELIF），一种技术设计为一个安全和微创的经皮fusion.Method和Subjects我们的技术适用于慢性腰痛患者，其中保守治疗无效，椎间盘变薄突出，并暂时缓解疼痛与磁盘块。在手术中，通过小切口插入7.5 mm鞘管进行经皮内窥镜椎间盘切除术，并使用L形牵开器经皮插入融合器。采用混合小关节螺钉固定代替椎弓根螺钉固定。腰痛改善，影像学证实骨愈合。这种技术被用于6例患者，没有手术相关的并发症occurred.Discussion在这个系列中使用的L形牵开器可以保护出口神经插入鞘，然后删除鞘，并放置在侧颅侧的圆角牵开器。该技术是安全的，没有其他相关风险。可插入大于鞘管的融合器，市售融合器适用于TLIF。结论PELIF是一种简单、安全、创伤小、完全经皮、创伤小的手术方法，采用L形牵开器和混合式小关节螺钉固定，可有效地解决传统经椎弓根螺钉固定和经椎板小关节螺钉固定的问题。这种手术可以作为与椎间盘退变相关的严重腰痛患者的治疗选择。
Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion.Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred.Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures.Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.