Oertel Joachim M, Burkhardt Benedikt W
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
World Neurosurg. 2017 Jul;103:410-418. doi: 10.1016/j.wneu.2017.03.132. Epub 2017 Apr 5.
Almost every surgical approach carries the risk of causing some degree of spinal instability, especially in cases of excessive resection of the lamina and facet joint. This study describes the endoscopic intralaminar approach (ILA) for the treatment of cranially and caudally migrated lumbar disc herniation.
Thirty-one patients who underwent endoscopic ILA for 26 caudally and 5 cranially migrated lumbar disc herniations were identified from a prospectively database. At final follow-up, a personal examination and a standardized questionnaire evaluation were conducted, including the Oswestry Disability Index (ODI) and functional outcome according to modified MacNab criteria. In addition, particular reference was given to back pain, leg pain, and repeat procedures.
The mean final follow-up was 37.0 months (range, 5-57 months) at which 29 patients attended (93.5%). No leg pain was noted in 95.0%, no back pain in 85.0%, full motor strength in 95.0%, and no sensory deficit in 95.0% of patients with ILA. Clinical success was reported by 95.0% of patients and the mean ODI was 9% in patients with ILA. Ten patients had an enlargement of ILA to conventional laminotomy (32.3%). By comparison of clinical outcome and repeat procedure rate in patients with ILA with patients with enlargement to laminotomy, no significant differences were identified except for higher ODI (i.e., 16%) in patients with enlargement of ILA.
Endoscopic ILA is a safe technique for the treatment of cranially and caudally migrated lumbar disc herniations. Careful procedural planning is recommended to protect soft tissue and osseous structures and to achieve excellent clinical outcome.
几乎每种手术入路都有导致某种程度脊柱不稳定的风险，尤其是在椎板和小关节切除过多的情况下。本研究描述了用于治疗上下移位型腰椎间盘突出症的内镜下椎板内入路（ILA）。
从一个前瞻性数据库中确定了31例行内镜下ILA治疗26例向下和5例向上移位型腰椎间盘突出症的患者。在末次随访时，进行了个人检查和标准化问卷调查评估，包括Oswestry功能障碍指数（ODI）和根据改良MacNab标准评估的功能结果。此外，特别关注背痛、腿痛和再次手术情况。
平均末次随访时间为37.0个月（范围5 - 57个月），29例患者（93.5%）参与随访。ILA治疗的患者中，95.0%无腿痛，85.0%无背痛，95.0%肌力完全正常，95.0%无感觉障碍。95.0%的患者报告临床成功，ILA治疗患者的平均ODI为9%。10例患者的ILA扩大为传统椎板切开术（32.3%）。将ILA治疗患者与扩大为椎板切开术患者的临床结果和再次手术率进行比较，除ILA扩大患者的ODI较高（即16%）外，未发现显著差异。
内镜下ILA是治疗上下移位型腰椎间盘突出症的一种安全技术。建议进行仔细的手术规划，以保护软组织和骨性结构并获得良好的临床结果。
