Koga S, Sairyo K, Shibuya I, Kanamori Y, Kosugi T, Matsumoto H, Kitagawa Y, Sumita T, Dezawa A
Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
Asian J Endosc Surg. 2012 Feb;5(1):34-7. doi: 10.1111/j.1758-5910.2011.00118.x.
In this report, we introduce two cases of recurrent herniated nucleus pulposus (HNP) at L5-S1 that were successfully removed using the small incised microendoscopic discectomy (sMED) technique, proposed by Dezawa and Sairyo in 2011. sMED was performed via the interlaminar approach with a percutaneous endoscope. The patients had previously underdone microendoscopic discectomy for HNP. For the recurrent HNP, the sMED interlaminar approach was selected because the HNP occurred at the level of L5-S1; the percutaneous endoscopic transforaminal approach was not possible for anatomical reasons. To perform sMED via the interlaminar approach, we employed new, specially made devices to enable us to use this technique. In conclusion, sMED is the most minimally invasive approach available for HNP, and its limitations have been gradually eliminated with the introduction specially made devices. In the near future, percutaneous endoscopic surgery could be the gold standard for minimally invasive disc surgery.
在本报告中，我们介绍了两例L5-S1节段复发性腰椎间盘突出症（HNP）患者，他们采用了2011年出泽和斋藤提出的小切口显微内镜下椎间盘切除术（sMED）技术成功切除病变。sMED通过经皮内窥镜经椎板间入路进行。患者之前曾因HNP接受过显微内镜下椎间盘切除术。对于复发性HNP，选择sMED经椎板间入路是因为HNP发生在L5-S1节段；由于解剖学原因，经皮内镜下经椎间孔入路不可行。为了通过椎板间入路进行sMED，我们使用了新的特制器械，以使我们能够应用该技术。总之，sMED是治疗HNP的最微创方法，随着特制器械的引入，其局限性已逐渐消除。在不久的将来，经皮内镜手术可能会成为微创椎间盘手术的金标准。
