Evins Alexander I, Banu Matei A, Njoku Innocent, Elowitz Eric H, Härtl Roger, Bernado Antonio, Hofstetter Christoph P
Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA.
J Clin Neurosci. 2015 Apr;22(4):730-4. doi: 10.1016/j.jocn.2014.10.025. Epub 2015 Mar 2.
Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy.
椎间孔狭窄在腰椎退行性脊柱病中常导致神经根病。内镜下经椎间孔技术可在对组织破坏最小的情况下进入椎间孔。然而，内镜技术进行椎间孔减压的有效性尚未得到研究。我们评估了在尸体标本上于L3 - L4、L4 - L5和L5 - S1节段进行的内镜下经椎间孔切开术的影像学结果。手术前后均进行三维CT扫描以测量椎间孔高度和面积。椎间孔切开术后，进行全椎板切除术和关节突切除术以评估硬膜撕裂或神经根损伤情况。L3 - L4节段术前椎间孔高度从2.12±0.13cm增加到2.27±0.14cm，增幅为8.9%（p<0.01），椎间孔面积从2.21±0.18cm²增加到2.72±0.19cm²，增幅为24.8%（p<0.01）。在L4 - L5节段，术前椎间孔高度为1.87±0.17cm，面积为1.78±0.18cm²。内镜下椎间孔切开术使椎间孔高度增加了15.3%（2.11±0.15cm，p<0.05），面积增加了44.8%（2.51±0.21cm²，p<0.01）。在L5 - S1节段，脊柱关节病改变导致椎间孔高度（1.26±0.14cm）和椎间孔面积（1.17±0.18cm²）减小。术后，椎间孔高度增加了41.6%（1.74±0.09cm，p<0.05），面积增加了98.7%（2.08±0.17cm²，p<0.01）。随后通过标准中线入路检查发现1例S1神经根硬膜撕裂。内镜下椎间孔切开术可实现有效的椎间孔减压，不过仍需进行临床研究以进一步评估并发症和疗效。
