Reinshagen Clemens, Ruess Daniel, Molcanyi Marek, Redjal Navid, Walcott Brian Patrick, Goldbrunner Roland, Rieger Bernhard
Department of General Neurosurgery, University of Cologne, 62 Kerpener Street, Cologne 50937, Germany; Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of General Neurosurgery, University of Cologne, 62 Kerpener Street, Cologne 50937, Germany.
J Clin Neurosci. 2015 Jun;22(6):1030-5. doi: 10.1016/j.jocn.2015.01.013. Epub 2015 Apr 23.
We report eight patients with disc herniations who underwent sequestrectomy via a crossover translaminar technique. The lateral lumbar spinal canal can be divided into several regions: the subarticular, foraminal and extraforaminal zone. Due to its difficult surgical exposure, some authors refer to part of the subarticular and foraminal region as the hidden zone. Conventional approaches involve partial or total facet joint resection, introducing risk of postoperative instability. Under fluoroscopic guidance, a high speed drill was used to create a small, angled fenestration at the base of the spinous process aimed at the contralateral hidden zone. The nerve root was visualized and disc fragments were removed without facet joint violation. Patients were registered in the International Spine Registry, Spine Tango. Numeric rating scale (NRS), Oswestry disability index (ODI) and core outcome measures index (COMI) were used to evaluate outcome after 6 weeks and 3 months. Outcome was further statistically matched with the Spine Tango pool of patients who underwent sequestrectomy via conventional techniques. Postoperative CT scans showed the translaminar crossover approach with the preserved facet joints. There was significant postoperative improvement of NRS scores and ODI at all follow-up intervals. COMI achieved significant improvement at 3 months. Statistical comparison with Spine Tango data confirmed that the translaminar crossover approach matches the clinical results of the conventional techniques. This series is a proof of principle for a successful translaminar crossover approach to the lumbar hidden zone. The outcome is not inferior to conventional inter- and translaminar routes and the technique potentially offers risk reduction for postoperative instability by preserving facet joint function, especially in the case of recurrent disease.
我们报告了8例通过交叉经椎板技术进行椎间盘游离体切除术的椎间盘突出症患者。腰椎外侧椎管可分为几个区域：关节下区、椎间孔区和椎间孔外区。由于其手术暴露困难，一些作者将部分关节下区和椎间孔区称为隐匿区。传统方法包括部分或全部小关节突切除术，存在术后不稳定的风险。在荧光透视引导下，使用高速钻头在棘突根部向对侧隐匿区创建一个小的、成角度的开窗。显露神经根并在不破坏小关节突的情况下取出椎间盘碎片。患者被纳入国际脊柱注册库Spine Tango。使用数字评分量表（NRS）、Oswestry功能障碍指数（ODI）和核心结局指标指数（COMI）在6周和3个月后评估疗效。疗效进一步与通过传统技术进行游离体切除术的Spine Tango患者库进行统计学匹配。术后CT扫描显示了保留小关节突的经椎板交叉入路。在所有随访期间，NRS评分和ODI均有显著的术后改善。COMI在3个月时取得显著改善。与Spine Tango数据的统计学比较证实，经椎板交叉入路与传统技术的临床结果相当。本系列是成功的经椎板交叉入路治疗腰椎隐匿区的原理验证。其疗效不低于传统的椎间和经椎板入路，并且该技术通过保留小关节突功能可能降低术后不稳定的风险，尤其是在复发性疾病的情况下。
