Kanai Akifumi
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan.
Pain Med. 2009 Jan;10(1):76-84. doi: 10.1111/j.1526-4637.2008.00546.x.
Available percutaneous procedures for lumbar disk herniation are not sufficiently effective for large herniations. Percutaneous intradiscal high-pressure injection of saline (IDHP) is designed to tear the thinned posterior longitudinal ligament (PLL), leading to significant reduction in mechanical compression of nerves by the herniation. We evaluated the effectiveness of this new therapy for patients with refractory lumbar herniation.
We studied 25 patients with lumbar disk herniation-associated radiculopathy refractory to nonsurgical treatments. Under fluoroscopy in the lateral position, a Tuohy needle was advanced into the herniated disk. Following intradiscal anesthesia, a control glass syringe with Luer lock was attached to the needle for high-pressure intradiscal injection of saline. Pain was scored with a visual analog scale (VAS), and physical activity was assessed using the Japanese Orthopaedic Association (JOA) score.
Tearing of the PLL was confirmed by a sudden loss of resistance to injection and leakage of contrast medium out of the disk into the epidural space. No adverse events were noted during and after IDHP apart from mild lumbago that disappeared within a week. IDHP resulted in tearing of extruded and sequestered herniated disks and PLL in 20 (80%) patients, and significant improvement of VAS and JOA scores throughout the 6-month observation period. The mean procedural time was 18 min. MRI confirmed the disappearance of herniated material after tearing. IDHP was unsuccessful in five patients.
IDHP leads to prompt relief of pain, with good outcome in patients with lumbar disk large herniation resistant to medical treatment.
现有的用于腰椎间盘突出症的经皮手术对于大型突出症的效果不够显著。经皮椎间盘内高压注射生理盐水（IDHP）旨在撕裂变薄的后纵韧带（PLL），从而显著减轻突出物对神经的机械压迫。我们评估了这种新疗法对难治性腰椎间盘突出症患者的有效性。
我们研究了25例经非手术治疗无效的腰椎间盘突出症伴神经根病患者。在侧位透视引导下，将一根Tuohy针推进到突出的椎间盘内。椎间盘内麻醉后，将一个带有鲁尔锁的对照玻璃注射器连接到针上，用于椎间盘内高压注射生理盐水。使用视觉模拟量表（VAS）对疼痛进行评分，并使用日本骨科协会（JOA）评分评估身体活动情况。
通过注射阻力突然消失以及造影剂从椎间盘漏入硬膜外间隙，证实了PLL的撕裂。除了一周内消失的轻度腰痛外，IDHP期间及之后未观察到不良事件。IDHP导致20例（80%）患者的游离型和脱出型椎间盘及PLL撕裂，在整个6个月的观察期内VAS和JOA评分显著改善。平均手术时间为18分钟。MRI证实撕裂后突出物消失。5例患者IDHP治疗失败。
IDHP能迅速缓解疼痛，对于药物治疗无效的腰椎间盘大型突出症患者效果良好。
