Ruetten Sebastian, Komp Martin, Godolias Georgios
Department for Spine Surgery and Pain Therapy, Clinic for Orthopaedics and Traumatology, St. Anna-Hospital, Herne, Germany.
Spine (Phila Pa 1976). 2005 Nov 15;30(22):2570-8. doi: 10.1097/01.brs.0000186327.21435.cc.
Prospective study of patients with lumbar disc herniations who were operated on with a full-endoscopic uniportal transforaminal approach using an extreme lateral access.
To examine the technical possibilities of an extreme lateral access for full-endoscopic uniportal transforaminal surgery of lumbar disc herniations within the spinal canal. Also, to assess sufficient decompression, and the advantages and disadvantages of the minimally invasive procedure.
Conventional prolapsed disc operations can result in consecutive damage as a result of traumatization. The usual transforaminal access is posterolateral, and is associated with problems in reaching the epidural space directly with unhindered vision and, thus, with problems of sufficient decompression in lumbar disc herniations within the spinal canal.
A total of 463 patients were observed for 1 year. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version North American Spine Society Instrumentarium, Oswestry low back pain disability questionnaire.
There were no complications. Of the patients, 81% reported no longer having leg pain, and 14% had occasional pain. There was no worsening. The results were constant and are equal to those of conventional procedures. No patients presented with neural scarring; 7% had recurrence of the prolapse. The extreme lateral access was necessary to reach the sequestered material.
The technique presented is an adequate and safe alternative to conventional procedures, and has the advantages of a truly minimally invasive procedure. The extreme lateral access is required for the indications described. There are clear limitations outside these indications. The possibility of selecting an access from posterolateral to extreme lateral now enables surgery of lumbar disc herniations inside and outside the spinal canal.
对采用极外侧入路的全内镜单通道经椎间孔入路手术治疗腰椎间盘突出症患者的前瞻性研究。
探讨极外侧入路在椎管内腰椎间盘突出症全内镜单通道经椎间孔手术中的技术可行性。同时，评估充分减压情况以及该微创手术的优缺点。
传统的椎间盘突出症手术可能因创伤导致连续性损伤。通常的经椎间孔入路是后外侧入路，在直接无障碍视野下到达硬膜外间隙存在问题，因此，在椎管内腰椎间盘突出症的充分减压方面存在问题。
共观察463例患者1年。除了一般和特定参数外，还使用了以下测量工具：视觉模拟量表、德国版北美脊柱协会器械库、Oswestry下腰痛残疾问卷。
无并发症发生。患者中，81%报告不再有腿痛，14%偶尔有疼痛。病情无恶化。结果稳定，与传统手术相当。无患者出现神经瘢痕形成；7%有椎间盘突出复发。为取出游离物质，极外侧入路是必要的。
所介绍的技术是传统手术的一种合适且安全的替代方法，具有真正微创手术的优点。对于所述适应证需要极外侧入路。在这些适应证之外有明显局限性。现在从后外侧到极外侧选择入路的可能性使得能够对椎管内外的腰椎间盘突出症进行手术。
