Henmi Tatsuhiko, Terai Tomoya, Hibino Naohito, Yoshioka Shinji, Kondo Kenji, Goda Yuichiro, Tezuka Fumitake, Sairyo Koichi
Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital; and.
Department of Orthopedics, Tokushima University, Tokushima, Japan.
J Neurosurg Spine. 2016 Feb;24(2):275-280. doi: 10.3171/2015.4.SPINE141305. Epub 2015 Oct 13.
Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors' hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient's symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.
经皮内镜下椎间盘切除术（PED）是一种微创椎间盘手术，可在局部麻醉下进行，仅需8毫米的皮肤切口。对于伴有椎间孔狭窄的经韧带突出的髓核，采用单纯经椎间孔入路很难取出移位的肿块。对于此类困难病例，椎间孔扩大成形术和硬膜外腔镜技术很有用。一名29岁男性因腰腿痛就诊于作者所在医院。磁共振成像（MRI）显示巨大的椎间盘突出伴椎间孔狭窄。计划行经椎间孔PED以切除突出的肿块。通过由内向外技术，切除了突出肿块的基底部。在椎间孔扩大成形术后，将套管移入硬膜外腔。在神经根下方进行硬膜外观察时，确认并整块切除了经韧带突出的碎片。术后患者症状立即缓解。在经椎间孔PED手术中，椎间孔扩大成形术与硬膜外腔镜观察相结合是一种切除经韧带突出的椎间盘碎片的有用且可靠的技术。
