JAMA. 1989 Jan 6;261(1):105-9.
Percutaneous diskectomy, particularly using Onik's nucleotome, has promise. It is too early, however, to decide if the percutaneous approach to reducing lumbar disk herniation will achieve a permanent place in the surgical armamentarium. Nevertheless, it is clear that patient selection is important. At the minimum, an adequate trial of conservative therapy must be followed by diagnostic imaging that documents a herniation that can be treated in this fashion and correlates with the patient's neurological signs and symptoms. If free fragments are found, a laminectomy of some sort will be required to remove the offending material. Patients who are at risk for general anesthesia or may be allergic to chymopapain were mentioned by the panel as special subpopulations for whom the procedure may be indicated despite the lack of wide experience with it. The rapidly rising popularity of automated percutaneous lumbar diskectomy via the nucleotome will hopefully be followed in the near future with larger studies with long-term follow-up.
经皮椎间盘切除术，尤其是使用奥尼克髓核切割器的方法，具有前景。然而，要确定经皮治疗腰椎间盘突出症的方法是否会在手术器械库中占据永久地位，目前还为时过早。不过，很明显患者的选择很重要。至少，在进行充分的保守治疗试验后，必须进行诊断性成像，以记录可以通过这种方式治疗且与患者神经体征和症状相关的椎间盘突出。如果发现游离碎片，则需要某种椎板切除术来清除有害物质。专家小组提到，有全身麻醉风险或可能对木瓜凝乳蛋白酶过敏的患者是特殊亚群，尽管对此方法缺乏广泛经验，但该手术可能适用于他们。通过髓核切割器进行的自动经皮腰椎间盘切除术迅速普及，有望在不久的将来开展更大规模的长期随访研究。
