Sairyo Koichi, Kitagawa Yasuhiro, Dezawa Akira
Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
Asian J Endosc Surg. 2013 Nov;6(4):292-7. doi: 10.1111/ases.12055. Epub 2013 Aug 22.
Percutaneous endoscopic discectomy (PED) for herniated nucleus pulposus has become increasingly popular since first reported by Yeung and Tsou. Additionally, radiofrequency thermal annuloplasty (TA) with PED (PED/TA) has been reported to be effective for discogenic low back pain. We used the PED/TA procedure to successfully treat four professional athletes with discogenic low back pain.
All patients were men; their age at operation was 35, 35, 34, and 28 years. Daily low back pain was provoked by discography in all four patients, who had been receiving conservative but ineffective treatment for over 1 year. Surgery was conducted with the patients under local anesthesia. A cannula was placed posterior to the disc and ventral to the posterior annulus fibrosus through a 7-mm skin incision. Degenerated nucleus pulposus at the site was removed percutaneously and the posterior annulus was modulated by bipolar radiofrequency TA.
After surgery, low back pain was resolved in all cases. After effective post-surgical rehabilitation with a physical trainer or physical therapist, all patients returned to their original competitive level.
PED/TA is a minimally invasive and effective procedure for discogenic low back pain, especially in athletes.
自杨和邹首次报道以来，经皮内镜下椎间盘切除术（PED）治疗髓核突出症越来越受欢迎。此外，有报道称，PED联合射频热凝纤维环成形术（TA）（PED/TA）对椎间盘源性下腰痛有效。我们采用PED/TA手术成功治疗了4例患有椎间盘源性下腰痛的职业运动员。
所有患者均为男性；手术年龄分别为35岁、35岁、34岁和28岁。所有4例患者经椎间盘造影诱发日常下腰痛，均接受了1年以上的保守治疗但无效。手术在局部麻醉下进行。通过7毫米的皮肤切口，在椎间盘后方、纤维环后部腹侧置入套管。经皮切除该部位退变的髓核，并用双极射频TA调节纤维环后部。
术后所有病例下腰痛均得到缓解。在接受体能训练师或物理治疗师的有效术后康复治疗后，所有患者均恢复到原来的竞技水平。
PED/TA是治疗椎间盘源性下腰痛的一种微创且有效的手术方法，尤其适用于运动员。
