Heo Dong Hwa, Kim Jin-Sung
Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon; and.
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Neurosurg Focus. 2017 Aug;43(2):E13. doi: 10.3171/2017.5.FOCUS17196.
OBJECTIVE Direct neural decompression cannot be achieved by performing lateral lumbar interbody fusion (LLIF). To overcome the indirect decompressive effect of LLIF, additional endoscopic discectomy with oblique lumbar interbody fusion (OLIF) has been attempted. The purpose of this study was to assess the clinical and radiological outcomes of patients who underwent OLIF with additional endoscopic discectomy. METHODS Spinal endoscopic discectomy-assisted OLIF was attempted to remove herniated disc material. Only patients with a follow-up time that exceeded 12 months were enrolled. Clinical parameters examined were the Oswestry Disability Index and visual analog scale scores of back and leg pain. Postoperative MRI was also performed. RESULTS Fourteen patients were enrolled. Central and foraminal disc herniations were evident in 8 and 6 patients, respectively. Concomitant central or foraminal herniated discs were removed completely after additional endoscopic discectomy, and disc removal was confirmed by postoperative MRI. Mean preoperative visual analog scale scores and Oswestry Disability Index scores improved postoperatively. CONCLUSIONS OLIF with additional endoscopic discectomy results in successful direct neural decompression without posterior decompressive procedures. Endoscopic assistance might overcome the limitations of LLIF.
目的 经外侧腰椎椎间融合术(LLIF)无法实现直接神经减压。为克服LLIF的间接减压效果,已尝试在斜外侧腰椎椎间融合术(OLIF)基础上增加内镜下椎间盘切除术。本研究旨在评估接受OLIF联合内镜下椎间盘切除术患者的临床和影像学结果。方法 尝试采用脊柱内镜辅助下的OLIF来切除突出的椎间盘组织。仅纳入随访时间超过12个月的患者。检查的临床参数包括Oswestry功能障碍指数以及背部和腿部疼痛的视觉模拟量表评分。术后还进行了MRI检查。结果 共纳入14例患者。分别有8例和6例患者存在中央型和椎间孔型椎间盘突出。在额外的内镜下椎间盘切除术后,合并的中央型或椎间孔型突出椎间盘被完全切除,术后MRI证实了椎间盘已被切除。术前视觉模拟量表评分和Oswestry功能障碍指数评分术后均有所改善。结论 OLIF联合内镜下椎间盘切除术可在不进行后路减压手术的情况下成功实现直接神经减压。内镜辅助可能克服LLIF的局限性。