Henmi Tatsuhiko, Terai Tomoya, Nagamachi Akihiro, Sairyo Koichi
Department of Orthopedic Surgery, Tokushima Prefectural Naruto Hospital, Naruto, Japan.
Department of Orthopedics, Tokushima University Graduate School of Medicine, Tokushima, Japan.
J Neurol Surg A Cent Eur Neurosurg. 2018 Jan;79(1):19-24. doi: 10.1055/s-0037-1599059. Epub 2017 Mar 20.
Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal.
In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery-related complications were reviewed.
There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4-L5, one case at L3-L4, and one case at L5-S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm before surgery to 88.4 mm after surgery ( < 0.05 by paired test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ∼ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED.
Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.
经皮内镜下腰椎间盘切除术（PED）是一种相对较新的技术，因其侵入性相对较小而越来越普遍。然而，一种可能的严重并发症是在内镜套管通过椎间孔插入神经管时出现出口神经损伤。最近建立了一种扩大椎间孔的技术，称为椎间孔成形术，以将套管安全地插入神经管的适当位置。
在本研究中，我们在局部麻醉下对15例患者进行了PED术中椎间孔成形术。使用手术前后的计算机断层扫描评估椎间孔的形态学变化。回顾手术相关并发症。
患者共15例，其中男性13例，女性2例，年龄21至86岁（平均：47.1岁）。椎间盘节段为L4-L5共13例，L3-L4 1例，L5-S1 1例。在50%的病例中，椎间孔平均面积从术前的58.6平方毫米显著增加到术后的88.4平方毫米（配对t检验，<0.05）。椎间孔在三个点处的直径均增加：上位椎体的下端板、椎间盘和下位椎体的上端板。面积增加了约1.5倍，尤其是在下位椎体的上端板处。所有病例在PED术中均未出现出口神经损伤。
椎间孔成形术是避免经椎间孔PED术中出口神经根损伤的有效方法。
