Ruetten S, Komp M, Godolias G
Department for Spine Surgery and Pain Therapy, Centre for Orthopaedics and Traumatology, St. Anna-Hospital Herne, University of Witten/Herdecke, Herne, Germany.
Minim Invasive Neurosurg. 2006 Apr;49(2):80-7. doi: 10.1055/s-2006-932172.
Even with good results, conventional disc operations may result in consecutive damage due to traumatisation. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. The transforaminal operation is the most common full-endoscopic procedure in surgery of the lumbar spine. It is frequently necessary to reach the spinal canal directly in order to achieve sufficient resection of lumbar disc herniations. Even in using a lateral approach, the authors recognise the clear limitations of the transforaminal procedure. The objective of this prospective study was to examine the technical possibility of a full-endoscopic interlaminar access. The focus was on questions of sufficient decompression, as well as advantages and disadvantages of the minimally invasive procedure. 331 patients were followed for 2 years. The results show that 82 % reported no longer having leg pain, and 13 % had only occasional pain. The decompression results are equivalent to those of conventional procedures. Traumatisation of both the access pathway and the spinal canal structures was reduced. Epidural scarring was minimised. The recurrence rate was 2.4 %. No serious surgical complications were observed. The authors view the technique described, which offers the advantage of a truly minimally invasive procedure, as a sufficient and safe alternative to conventional procedures, when the appropriate indication criteria are heeded. There are technical problems because of the small instruments. In conjunction with the transforaminal procedure, this is an expansion of the spectrum for full-endoscopic surgery of lumbar disc herniations.
即使手术效果良好，传统的椎间盘手术也可能因创伤而导致连续性损伤。由于内窥镜技术在手术操作和康复方面具有优势，已成为许多领域的标准术式。经椎间孔手术是腰椎手术中最常见的全内窥镜手术。为了充分切除腰椎间盘突出症，通常需要直接进入椎管。即使采用侧方入路，作者也认识到经椎间孔手术存在明显局限性。这项前瞻性研究的目的是探讨全内窥镜经椎板间隙入路的技术可行性。重点关注充分减压的问题以及微创手术的优缺点。对331例患者进行了为期2年的随访。结果显示，82%的患者报告腿痛消失，13%的患者仅偶尔疼痛。减压效果与传统手术相当。入路通道和椎管结构的创伤均有所减轻。硬膜外瘢痕形成减至最少。复发率为2.4%。未观察到严重的手术并发症。作者认为，当遵循适当的适应症标准时，所描述的技术具有真正微创手术的优势，是传统手术的一种充分且安全的替代方法。由于器械较小，存在技术问题。结合经椎间孔手术，这扩展了腰椎间盘突出症全内窥镜手术的范围。
