Eun Sang Soo, Eum Jin Hwa, Lee Sang Ho, Sabal Luigi Andrew
Department of Orthopaedics, Spine Health Wooridul Hospital, Gangnam-gu, Seoul, the Republic of Korea.
Department of Neurosurgery, Spine Health Wooridul Hospital, Pohang, the Republic of Korea.
J Neurol Surg A Cent Eur Neurosurg. 2017 Jul;78(4):390-396. doi: 10.1055/s-0036-1592157. Epub 2016 Sep 21.
Endoscopic lumbar diskectomy through the interlaminar window is gaining recognition. Most of the literature describes these endoscopic procedures using specialized uniportal multichannel endoscopes. However, a single portal limits the motion of the instruments and obscures visualization of the operating field. To overcome this limitation, we propose a new technique that utilizes two portals to access the spinal canal. The biportal endoscopic lumbar decompression (BELD) technique uses two portals to treat difficult lumbar disk herniations and also lumbar spinal stenoses. Seventeen patients were treated with BELD for 11 lumbar disk herniations and 6 lumbar spinal stenoses. Preoperative back and leg visual analog scale (VAS-B and VAS-L, respectively) scores and the Oswestry Disability Index (ODI) were recorded and compared with corresponding values on final follow-up. There was an average follow-up of 14 months. For the disk herniation group, preoperative VAS-L (7.8750 ± 1.24) and ODI (51.73 ± 18.57) was significantly different from follow-up postoperative VAS-L (0.87 ± 0.64, = 0.000) and ODI (9.37 ± 4.83, = 0.001). For the stenosis group, preoperative VAS-B (6.17 ± 1.94), VAS-L(7.83 ± 1.47), and ODI (63.27 ± 7.67) were significantly different from follow-up postoperative values (2.5 ± 1.04, = 0.022; 2.00 ± 1.67, = 0.001; 24.00 ± 6.45, = 0.000, respectively). One patient underwent revision microdiskectomy for incomplete decompression. BELD can achieve a similar decompression effect as microdiskectomy and unilateral laminotomy for bilateral decompression with a smaller incision than tubular diskectomy.
经椎板间隙入路的内镜下腰椎间盘切除术正逐渐得到认可。大多数文献描述的这些内镜手术使用的是专门的单通道多通道内镜。然而，单一通道限制了器械的活动，且使手术视野的可视化受到影响。为克服这一局限性，我们提出一种利用两个通道进入椎管的新技术。双通道内镜下腰椎减压术（BELD）使用两个通道治疗复杂的腰椎间盘突出症以及腰椎管狭窄症。17例患者接受了BELD治疗，其中11例为腰椎间盘突出症，6例为腰椎管狭窄症。记录术前的背部和腿部视觉模拟评分（分别为VAS-B和VAS-L）以及Oswestry功能障碍指数（ODI），并与最终随访时的相应数值进行比较。平均随访时间为14个月。对于椎间盘突出症组，术前VAS-L（7.8750±1.24）和ODI（51.73±18.57）与术后随访时的VAS-L（0.87±0.64，P = 0.000）和ODI（9.37±4.83，P = 0.001）有显著差异。对于狭窄症组，术前VAS-B（6.17±1.94）、VAS-L（7.83±1.47）和ODI（63.27±7.67）与术后随访值（分别为2.5±1.04，P = 0.022；2.00±1.67，P = 0.001；24.00±6.45，P = 0.000）有显著差异。1例患者因减压不彻底接受了翻修显微椎间盘切除术。BELD可实现与显微椎间盘切除术和单侧椎板切开双侧减压术相似的减压效果，且切口比管状椎间盘切除术小。
