Kim Hyeun Sung, Ju Chang Il, Kim Seok Won, Kim Jong Gyue, Lee Seung Myung, Kim Byoung Wook
Department of Neurosurgery, Hurisarang Hospital, Daejeon, Korea.
Department of Neurosurgery, Chosun University, Gwangju, Korea.
Asian J Neurosurg. 2015 Apr-Jun;10(2):95-101. doi: 10.4103/1793-5482.154977.
Acute lumbar disc herniation can occur in every lumbar intervertebral disc space and in multiple levels simultaneously. In the cases of 2 levels adjacent lumbar disc herniations of severe unilateral radiculopathic leg pain caused by compression of the nerve roots, respectively, multiple incision or long incision is generally needed for simultaneous removal of disc fragment in 2 levels.
We proposed the minimally invasive one portal skin incision endoscopic discectomy is effective and safe method to treat 2 levels adjacent lumbar disc herniation.
We have experimented total 8 cases of 2 levels adjacent lumbar disc herniation having unilateral radiculopathic pain respectively. All cases are 2 levels adjacent lumbar disc herniation. We have tried a percutaneous endoscopic transforaminal approach through minimal one portal skin incision and remove the two herniated disc materials in the adjacent levels.
The L2-L3 level was involved in 2 patients, L3-L4 level in 6 patients, while the L4-L5 level was involved in 7 patients, L5-S1 level in 1 patient. The mean follow-up was 18.5 months. The mean visual analogue score (VAS) of the patients prior to surgery was 7.75, and the mean postoperative VAS was 2.375. According to Macnab's criteria, 3 patients had excellent results, 4 patients had good results, 1 patient had fair results, and no patient had a poor result; satisfactory results were obtained in 87.5% of the cases.
The percutaneous endoscopic transforaminal approach through 1 skin portal incision could be effective surgical method in unilateral adjacent 2 levels lumbar disc herniation.
急性腰椎间盘突出症可发生于每个腰椎间隙，且可同时累及多个节段。对于因神经根受压分别导致严重单侧神经根性腿痛的相邻两个节段腰椎间盘突出症患者，通常需要进行多个切口或长切口以同时摘除两个节段的椎间盘碎片。
我们提出经单切口皮肤入路的微创内镜下椎间盘切除术是治疗相邻两个节段腰椎间盘突出症的一种有效且安全的方法。
我们共对8例分别患有相邻两个节段腰椎间盘突出症且伴有单侧神经根性疼痛的患者进行了实验。所有病例均为相邻两个节段的腰椎间盘突出症。我们尝试通过最小化的单切口皮肤入路采用经皮内镜椎间孔入路，摘除相邻两个节段的突出椎间盘组织。
2例患者累及L2-L3节段，6例患者累及L3-L4节段，7例患者累及L4-L5节段，1例患者累及L5-S1节段。平均随访时间为18.5个月。患者术前视觉模拟评分（VAS）平均为7.75，术后平均VAS为2.375。根据Macnab标准，3例患者结果为优，4例患者结果为良，1例患者结果为可，无患者结果为差；87.5%的病例获得了满意结果。
经单皮肤切口的经皮内镜椎间孔入路可能是治疗单侧相邻两个节段腰椎间盘突出症的有效手术方法。
