Lysoń Tomasz, Mariak Zenon, Jadeszko Marek, Kochanowicz Jan, Lewko Janusz
Department of Neurosurgery, Medical University of Bialystok, Białystok.
Neurol Neurochir Pol. 2008 Mar-Apr;42(2):105-11.
Endoscopic methods are increasingly used in spine surgery, including the operative treatment of lumbar disc herniation. In this study we present a clinical series of 45 patients with lumbar disc prolapse who were operated on endoscopically with ENDOSPINE instrumentation (Karl STORZ GmbH and Co. KG), using the Destandau technique.
Between 2005 and 2006 endoscopy was used in 76 operations of lumbar disc prolapse and in 45 patients the entire procedure was performed endoscopically. All procedures were carried out from a posterior approach using a 4 mm Hopkins 0 degrees -telescope placed in the working insert equipped with channels for suction tube, operative instruments and nerve root retractor. The outcome was assessed using modified McNab criteria both directly and three months (in 35 patients) postoperatively.
Good to excellent outcome was achieved in 89% of patients, which is consistent with results reported by experienced authors and comparable with results of "classic" microdiscectomy. Five patients reported no improvement and 3 of them were subsequently reoperated using the open surgical approach. In 3 patients the dural sac was lacerated but none of the tears exceed a few millimetres in length and they were not associated with neural injury. They were easily repaired endoscopically with a patch of "Tachocomb" tissue sealant.
Destandau microendoscopic discectomy (MED) is a novel, safe and effective method that minimizes invasiveness of the surgical approach. Results achieved with this method are comparable to those achieved with "classic" microdiscectomy.
内镜技术在脊柱手术中的应用日益广泛，包括腰椎间盘突出症的手术治疗。在本研究中，我们报告了一组临床病例，45例腰椎间盘突出症患者采用ENDOSPINE器械（卡尔史托斯有限责任公司）并运用德斯唐多技术进行了内镜手术。
2005年至2006年间，76例腰椎间盘突出症手术采用了内镜技术，其中45例患者整个手术过程均在内镜下完成。所有手术均采用后入路，使用4毫米0度霍普金斯望远镜置于工作套管中，该套管配有吸引管、手术器械和神经根牵开器的通道。分别于术后即刻及术后三个月（35例患者）采用改良麦克纳布标准评估手术效果。
89%的患者取得了良好至优秀的手术效果，这与经验丰富的作者所报告的结果一致，且与“经典”显微椎间盘切除术的结果相当。5例患者报告无改善，其中3例随后采用开放手术入路再次手术。3例患者硬脊膜囊撕裂，但撕裂长度均未超过几毫米，且未伴有神经损伤。使用“速即纱”组织密封剂贴片在内镜下轻松修复。
德斯唐多显微内镜椎间盘切除术（MED）是一种新颖、安全且有效的方法，可最大程度减少手术入路的创伤性。该方法所取得的结果与“经典”显微椎间盘切除术相当。
