Tonosu Juichi, Oshima Yasushi, Shiboi Ryutaro, Hayashi Akihiko, Takano Yuichi, Inanami Hirohiko, Koga Hisashi
Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan;; Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan.
Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
J Spine Surg. 2016 Dec;2(4):281-288. doi: 10.21037/jss.2016.11.05.
Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments of lumbar disc herniation (LDH), and has three different operative approaches. This study focused on the interlaminar approach (ILA) and investigated the appropriate operative route for this approach.
ILA was performed in 41 patients with LDH. The width of the interlaminar space, LDH size, and positional relation between LDH and the corresponding nerve root were radiologically evaluated. Thirty-three LDHs were removed via the shoulder of the corresponding nerve root and eight were removed via the axilla of the corresponding nerve root and dural sac. Pre- and postoperative status were evaluated using the modified Japanese Orthopedic Association (mJOA) and numerical rating scale (NRS) scores.
The mean age was 41.5 years; there was single-level involvement, mostly at L5/S1 (33 cases). The mean recovery rate of mJOA score was 59.8% and mean pre- and postoperative NRS scores were 5.8 and 0.98, respectively. Relatively severe complications developed in three patients treated by ILA via the shoulder. There was persistent numbness in the corresponding nerve area, transient muscular weakness, and transient bladder and rectal disturbance, may be due to excessive compression of the nerve root and/or dural sac by the endoscopic sheath.
ILA can be used to treat LDH revealing an interlaminar space of ≥20 mm. The procedure is minimally invasive and effective; however, appropriate selection of an operative route is important to avoid operative complications. Particularly for large LDH, the operative route via the axilla should be considered.
经皮内镜下腰椎间盘切除术（PELD）是腰椎间盘突出症（LDH）的微创治疗方法之一，有三种不同的手术入路。本研究聚焦于椎板间入路（ILA），并探讨该入路的合适手术路径。
对41例LDH患者行ILA手术。通过影像学评估椎板间隙宽度、LDH大小以及LDH与相应神经根的位置关系。33例LDH经相应神经根肩部入路切除，8例经相应神经根腋部及硬膜囊入路切除。采用改良日本骨科学会（mJOA）评分和数字评定量表（NRS）评分评估术前和术后状况。
平均年龄41.5岁；均为单节段受累，主要位于L5/S1（33例）。mJOA评分的平均恢复率为59.8%，术前和术后NRS评分均值分别为5.8和0.98。3例经神经根肩部行ILA手术的患者出现了相对严重的并发症。相应神经区域持续麻木、短暂性肌肉无力以及短暂性膀胱和直肠功能障碍，可能是由于内镜鞘对神经根和/或硬膜囊过度压迫所致。
ILA可用于治疗椎板间隙≥20mm的LDH。该手术微创且有效；然而，正确选择手术路径对于避免手术并发症很重要。特别是对于大型LDH，应考虑经腋部的手术路径。
