Jha Subash C, Tonogai Ichiro, Takata Yoichiro, Sakai Toshinori, Higashino Kosaku, Matsuura Tetsuya, Suzue Naoto, Hamada Daisuke, Goto Tomohiro, Nishisho Toshihiko, Tsutsui Takahiko, Goda Yuichiro, Abe Mitsunobu, Mineta Kazuaki, Kimura Tetsuya, Nitta Akihiro, Hama Shingo, Higuchi Tadahiro, Fukuta Shoji, Sairyo Koichi
Department of Orthopedics, Tokushima University, Tokushima, Japan. 2. Department of Orthopedics and Traumatology, Kathmandu University Hospital, Dhulikhel, Nepal.
J Med Invest. 2015;62(1-2):100-2. doi: 10.2152/jmi.62.100.
Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.
需要手术干预的腰椎间盘突出症的显微外科手术已有详尽描述。方法从传统的开放式椎间盘切除术到微创技术不等。由于该手术需要全身麻醉，所有手术都需要对患者进行充分的麻醉前准备，并且需要进行神经监测以防止医源性神经损伤。传统的手术技术有时需要切除相应的椎板以评估神经根和突出的椎间盘，这可能会增加椎体后柱不稳定的风险。如果发生这种情况，可能需要进行融合手术，这会进一步增加发病率和成本。我们在此介绍一例因腰椎间盘碎片导致急性马尾综合征的病例，该病例在局部麻醉下通过经椎间孔入路在清醒患者中进行了内镜下切除。局部麻醉下的经皮内镜下椎间盘切除术被证明是开放式背部手术的更好替代方案，因为它使立即干预成为可能，围手术期并发症和发病率更少，软组织损伤最小化，并允许早期康复，效果更好，患者满意度更高。除了这些优点外，经皮内镜下椎间盘切除术还为后续手术（无论是开放式还是微创式）可能需要的其他入路提供了保护。
