Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations
Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations
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DOI：
10.3171/spi.2001.94.2.0216
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发表时间：
2001-04-01
影响因子：
4.1
通讯作者：
Fagone, KL
中科院分区：
文献类型：
--
作者：
Lew, SM;Mehalic, TF;Fagone, KL
目的。极外侧（椎间孔外）和椎间孔型椎间盘突出症占所有椎间盘突出症的比例高达11%。手术治疗在技术上可能存在困难，最佳的手术治疗方法仍存在争议。经皮椎间孔入路内镜下处理这些外侧椎间盘突出症相较于更传统的手术方法具有一些理论优势。本研究的目的是评估经皮椎间孔内镜入路治疗极外侧和椎间孔型椎间盘突出症患者的安全性和有效性。
方法。对连续47例经此入路手术的患者进行回顾性分析。所有手术均在局部麻醉诱导后于门诊进行。通过Macnab标准以及确定患者的恢复工作状态来评估结果。中位随访时间为18个月（范围4 - 51个月）。47例患者中有40例（85%）获得优或良的结果。在症状出现前工作的38例患者中，34例（90%）恢复工作。5例患者（11%）结果不佳，随后在同一节段进行了开放手术。在10例接受工人赔偿的患者中，Macnab标准显示结果明显较差（70%为优或良），但恢复工作状态良好（90%）。无并发症发生。
结论。经皮椎间孔内镜下椎间盘切除术在治疗极外侧和椎间孔型椎间盘突出症方面是安全有效的。
Object. Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treat ing patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach.Methods. A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4-51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worst outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications.Conclusions. Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.