Soldner F, Hoelper B M, Wallenfang Th, Behr R
Department of Neurosurgery, Klinikum Fulda, Germany.
Acta Neurochir (Wien). 2002 Apr;144(4):315-20. doi: 10.1007/s007010200043.
The interlaminar approach is the standard procedure for most disc herniations in lumbar spine surgery. However, in cranially extruded disc herniations including canalicular herniations, partial or complete facetectomy is necessary with increased risk of postoperative spinal instability. We present the translaminar technique which allows a more direct and less destructive operative approach.
30 patients using the translaminar fenestration were analysed by a postoperative follow-up of 6 weeks and one year. The mean-age was 57.2 years. For resection of the disc herniation, a small round or oval fenestration (6-8 mm) in the hemilamina, craniomedially to the facet joint, was performed. No patient received a partial or total facetectomy.
The majority of affected discs were at the L4-L5 level (53%). An extruded fragment was found in 28 patients (93%). In 5 patients bleeding from epidural veins complicated the intra-operative course. In 50% the nerve root was visually exposed. 15 patients (50%) had an intervertebral discectomy additional to the fragment excision. One patient was re-operated on after 10 days because of persisting radicular pain by using the same translaminar approach. 28 patients showed complete or nearly complete relief of radicular pain. Using this approach we have seen no major complication or clinical instability during a follow-up of at least one year.
The translaminar approach is an effective and minimally invasive technique in both canalicular and cranio-dorsolateral disc herniations. It gives an additional possibility to avoid partial removal of the facet joints, can be performed in all lumbar segments and preserves structures important for segmental spinal stability. The approach allows access to the extruded disc fragment and intervertebral disc space comparable to classical approaches and is a frequently used operative technique in our department.
椎板间入路是腰椎间盘突出症手术中大多数椎间盘突出的标准术式。然而，对于包括椎管内疝出在内的高位椎间盘突出症，部分或完全切除小关节突是必要的，但术后脊柱不稳定的风险会增加。我们介绍一种经椎板技术，该技术可提供更直接且破坏性更小的手术入路。
对30例行经椎板开窗术的患者进行了为期6周和1年的术后随访分析。平均年龄为57.2岁。为切除椎间盘突出，在小关节突颅内侧的半椎板上做一个小的圆形或椭圆形开窗（6 - 8毫米）。没有患者接受部分或全小关节突切除术。
大多数受累椎间盘位于L4 - L5节段（53%）。28例患者（93%）发现有突出碎片。5例患者术中出现硬膜外静脉出血，使手术过程复杂化。50%的患者神经根在直视下暴露。15例患者（50%）在切除碎片的基础上还进行了椎间盘切除术。1例患者在术后10天因持续神经根性疼痛，采用相同的经椎板入路再次手术。28例患者神经根性疼痛完全或几乎完全缓解。采用该入路，在至少1年的随访中未发现重大并发症或临床不稳定情况。
经椎板入路在椎管内及颅后外侧椎间盘突出症中是一种有效且微创的技术。它为避免部分切除小关节突提供了额外的可能性，可在所有腰椎节段进行，并且保留了对节段性脊柱稳定性重要的结构。该入路可到达突出的椎间盘碎片和椎间盘间隙，与传统入路相当，是我们科室常用的手术技术。
