Krzok Guntram, Telfeian Albert E, Wagner Ralf, Iprenburg Menno
SRH Hospital Waltershausen-Friedrichroda, Friedrichroda, Germany.
Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
J Spine Surg. 2016 Dec;2(4):310-313. doi: 10.21037/jss.2016.09.02.
Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet.
Two patient cases are described where the lumbar 4-5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization.
Following surgery, the patients' symptoms showed immediate regression with complete relief of one patient's foot drop by 6 months.
Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle.
腰椎小关节囊肿是导致腰椎神经根病的一种良性、退行性且相当罕见的病因。腰椎小关节囊肿的标准外科治疗通常需要进行椎板切除术和内侧小关节切除术，这可能会进一步破坏病变运动节段的稳定性。作者在此介绍一种经椎弓根内镜进入病变部位的新技术，该技术无需侵犯椎板或小关节。
描述了两例患者病例，其中腰4-5小关节囊肿位于椎弓根内侧。通过钻穿相邻椎弓根建立经皮进入囊肿的通道，形成一个7毫米的通道，为内镜管状牵开器和工作通道内镜建立通路。使用直钳和可弯曲钳在直视下切除囊肿。
手术后，患者症状立即缓解，其中一名患者的足下垂在6个月时完全缓解。
经椎弓根内镜入路被描述为一种针对清醒患者的新型微创手术选择，用于治疗腰4或腰5椎弓根附近的腰椎小关节囊肿。
