Uniyal Priyank, Choi Gun, Khedkkar Bhushan
Pohang Wooridul Hospital, Pohang, Korea.
Int J Spine Surg. 2016 Sep 7;10:31. doi: 10.14444/3031. eCollection 2016.
Since Kambin introduced the concept of percutaneous transforaminal disc surgery in 1973, there has been numerous advances in the field of spine endoscopy and the concept of central debulking of the disc has changed to targeted fragmentectomy and disc preservation. The lumbar disc fragments which are down migrated and to the medial aspect of the pedicle are extremely challenging to deal by transforaminal approach even after foraminoplasties and by various other approaches. Therefore most spine surgeons prefer open procedures which requires extensive removal of pars and facet leading to the risk of instability.
To describe a safe and effective technique for lumbar intra-canal high grade down migrated disc herniation, medial to the pedicle by transpedicular endoscopy.
Two patients underwent percutaneous transpedicular lumbar endoscopy under local anaesthesia for high grade down migrated disc herniation and for discal cyst at the medial aspect of pedicle respectively.
We achieved the complete successful decompression by percutaneous transpedicular lumbar endoscopy.
Authors found this technique very promising in complete removal of disc material under direct visualisation for high grade down disc herniations.
自1973年坎宾引入经皮椎间孔椎间盘手术的概念以来，脊柱内镜领域取得了诸多进展，椎间盘中央减压的概念已转变为靶向切除术和椎间盘保留。即使在进行椎间孔扩大成形术及采用各种其他方法后，经椎间孔途径处理向下移位至椎弓根内侧的腰椎间盘碎片仍极具挑战性。因此，大多数脊柱外科医生更倾向于开放手术，而这需要广泛切除椎弓根峡部和小关节，从而导致不稳定的风险。
描述一种通过经椎弓根内镜治疗腰椎管内高位向下移位椎间盘突出症（位于椎弓根内侧）的安全有效技术。
两名患者分别在局部麻醉下接受了经皮经椎弓根腰椎内镜手术，一例为高位向下移位椎间盘突出症，另一例为椎弓根内侧的椎间盘囊肿。
我们通过经皮经椎弓根腰椎内镜实现了完全成功减压。
作者发现该技术在直视下完全切除高位向下移位椎间盘突出症的椎间盘组织方面非常有前景。
