Erdine Serdar, Ozyalçin Nuri Süleyman, Cimen Ali
Istanbul University Istanbul Faculty of Medicine, Department of Algology, Istanbul, Turkey.
Agri. 2005 Apr;17(2):17-22.
Low-back pain is one of the most common causes for seeking professional medical assistance and the most frequent cause of absence from work. It is not rare that the intervertebral discs are the etiological factor. Degenerated discs with internal disruptions may cause axial back pain whereas protrusion or herniation of a disc may result in radicular pain. Open surgical procedures targeting the intervertebral discs are carried out frequently for years. But especially because of its lack of superiority over the conventional therapies in the long-term and the risk of development of failed back surgery syndrome, the investigators are forced to develop minimally invasive techniques of disc decompression. In the last two decades, better understanding of the spinal anatomy, function and pain generating mechanisms along with the technological achievements, has accelerated the development of many modalities for the treatment of low back pain. Chemonucleolysis, automated percutaneous lumbar discectomy (APLD), intradiscal laser discectomy, intradiscal electrothermal therapy (IDET) and most recently percutaneous nucleoplasty are the minimally invasive techniques developed for this aim. Percutaneous nucleoplasty is a minimally invasive technique which uses radiofrequency energy to ablate the nucleus pulposus in a controlled manner for disc decompression. The current data about this new technique is insufficient yet, but the preliminary reports indicate that the technique is relatively safe and the outcomes are encouraging.
腰痛是寻求专业医疗帮助的最常见原因之一,也是旷工的最常见原因。椎间盘作为病因并不罕见。内部结构破坏的退变椎间盘可能导致轴向背痛,而椎间盘突出或脱出可能导致神经根性疼痛。多年来,针对椎间盘的开放性手术经常进行。但特别是由于其在长期疗效上并不优于传统疗法,且存在发生腰椎手术失败综合征的风险,研究人员被迫开发微创椎间盘减压技术。在过去二十年中,对脊柱解剖结构、功能和疼痛产生机制的更好理解以及技术成就,加速了多种治疗腰痛方法的发展。化学髓核溶解术、自动经皮腰椎间盘切除术(APLD)、椎间盘内激光椎间盘切除术、椎间盘内电热疗法(IDET)以及最近的经皮髓核成形术都是为此目的而开发的微创技术。经皮髓核成形术是一种微创技术,它利用射频能量以可控方式消融髓核以实现椎间盘减压。关于这项新技术的现有数据尚不充分,但初步报告表明该技术相对安全且效果令人鼓舞。