Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope
Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope
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DOI：
10.1227/01.neu.0000192713.95921.4a
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发表时间：
2006-02-01
期刊：
影响因子：
4.8
通讯作者：
Chae, YS
中科院分区：
文献类型：
--
作者：
Choi, G;Lee, SH;Chae, YS
目的：经皮内窥镜经椎间孔椎间盘切除术常被用作腰椎间盘突出症的微创手术。然而，经椎间孔入路在L5-S1节段存在局限性，这是由于解剖结构的限制，例如髂嵴较高或椎间孔较小，尤其是对于移位的大椎管内椎间盘突出。我们讨论的程序和经皮内窥镜椎板间椎间盘切除术的临床结果，使用刚性工作通道内窥镜在L5-S1水平和相关的手术anatomy.METHODS：我们进行了经皮内窥镜椎间盘切除术通过椎板间的方法在67例患者谁满足我们的入选标准期间，从2002年3月至2002年11月。所有手术均在局部麻醉下进行。在荧光镜引导下，我们使用靛蓝胭脂红混合不透射线染料进行椎间盘造影。然后将6 mm工作通道内窥镜引入硬膜外腔。在清晰的内窥镜可视化下使用镊子和激光去除突出的椎间盘材料。我们回顾性评估了65例随访超过1.5年的病例。采用视觉模拟评分法（VAS）和奥斯韦斯特里功能障碍指数（ODI）对患者进行评估。（术前平均7.89;术后平均1.58）和ODI（术前平均57.43;术后平均值，11.52）显示，与术前评分相比，末次随访检查时其数值有统计学显著性（P = 0.00）改善。研究组中90.8%的人显示良好的结果。平均住院时间为12小时。重返工作岗位的平均时间为6.79周。并发症包括2例硬膜损伤伴脑脊液漏，9例一过性感觉迟钝，1例复发。两名患者在初次手术时需要转为开放手术。有任何patients.CONCLUSION：经皮内窥镜下椎板间椎间盘切除术是一种安全，有效，微创的程序，用于治疗椎管内椎间盘突出在L5-S1水平在适当选择的情况下，特别是当transforaminal方法是不可能的，因为解剖的限制。
OBJECTIVE: Percutaneous endoscopic transforaminal discectomy is often used as a minimally invasive procedure for lumbar disc herniation. However, a transforaminal approach posts limitations at the L5-S1 level owing to anatomic constraints, such as a high iliac crest or small intervertebral foramen and especially for migrated large intracanalicular disc herniations. We discuss the procedure and clinical results of percutaneous endoscopic interlaminar discectomy using a rigid working channel endoscope at the L5-S1 level and the relevant surgical anatomy.METHODS: We performed percutaneous endoscopic discectomy through the interlaminar approach in 67 patients who satisfied our inclusion criteria during the period from March 2002 to November 2002. All procedures were performed under local anesthesia. Under fluoroscopic guidance, we performed discography using indigocarmine mixed with radio-opaque dye. The 6-mm working channel endoscope was then introduced into the epidural space. Herniated disc material was removed using forceps and laser under clear endoscopic visualization. We retrospectively evaluated the 65 cases with more than 1.5 years of follow-up. The patients were evaluated using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI).RESULTS: VAS for leg pain (preoperative mean, 7.89; postoperative mean, 1.58) and ODI (preoperative mean, 57.43; postoperative mean, 11.52) showed statistically significant (P = 0.00) improvement in their values at the last follow-up examination compared with preoperative scores. Of the study group, 90.8% individuals showed favorable result. The mean hospital stay was 12 hours. The average time to return to work was 6.79 weeks. Complications included two cases of dural injury with cerebrospinal fluid leakage, nine cases of dysesthesia that were transient, and one case of recurrence. Two patients required conversion to open procedure at the initial operation. There was no evidence of infection in any patients.CONCLUSION: Percutaneous endoscopic interlaminar discectomy is a safe, effective, and minimally invasive procedure for the treatment of intracanalicular disc herniations at the L5-S1 level in properly selected cases, especially when the transforaminal approach is not possible because of anatomic constraints.