Hussain Namath S, Perez-Cruet Mick
Department of Neurosurgery, Penn State Hershey Medical Center.
Michigan Head and Spine Institute, Oakland University William Beaumont School of Medicine.
Cureus. 2016 Jun 2;8(6):e628. doi: 10.7759/cureus.628.
Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group's operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results. Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times. Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies.
背景 微创椎板切除术是治疗腰椎管狭窄症的一种非常有效的手术方法。然而，这项技术在操作上可能具有挑战性，尤其是对于患有严重狭窄的患者。从单侧入路进行对侧减压在切除肥厚的黄韧带时可能导致硬脊膜切开。通过小工作通道治疗这种并发症可能很困难。目的 详细介绍我们团队使用二氧化碳激光的手术经验，并讨论我们的结果以及文献中先前报道结果的研究。方法 在微创椎板切除术中，研究了二氧化碳激光（Omniguide，马萨诸塞州波士顿）对侧黄韧带的手术消融。迄今为止，已对40个节段进行了研究。研究了安全充分干燥和切除黄韧带所需的电压量以及该技术的有效性。结果 使用二氧化碳激光9至11瓦连续波长（10,600纳米）功率设置可有效切除对侧黄韧带。对侧黄韧带的收缩便于使用2号Kerrison咬骨钳将其切除。未发生硬脊膜切开，并且使用激光并未显著延长手术时间。结论 二氧化碳激光似乎是微创脊柱外科医生可用器械库中的一种有用工具，并且在进行微创椎板切除术时可能有助于降低硬脊膜切开的发生率。
