Ahn Jae-Sung, Lee Ho-Jin, Choi Dae-Jung, Lee Ki-Young, Hwang Sung-Jin
1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon; and.
2Spine Center, Department of Orthopaedic Surgery, Barun Hospital, Jin-ju, South Korea.
J Neurosurg Spine. 2018 May;28(5):492-498. doi: 10.3171/2017.8.SPINE17771. Epub 2018 Feb 23.
This study was performed to describe the extraforaminal approach of biportal endoscopic spinal surgery (BESS) as a new endoscopic technique for transforaminal decompression and discectomy and to demonstrate the clinical outcomes of this new procedure for the first time. Twenty-one patients (27 segments) who underwent the extraforaminal approach of BESS between March 2015 and April 2016 were enrolled according to the inclusion and exclusion criteria. The operative time (minutes/level) and complications after the procedure were recorded. The visual analog scale (VAS) score was checked to assess the degree of radicular leg pain preoperatively and at the time of the last follow-up. The modified Macnab criteria were used to examine the clinical outcomes at the time of the last follow-up. The mean duration of the follow-up period was 14.8 months (minimum duration 12 months). The mean operative time was 96.7 minutes for one level. The mean VAS score for radicular leg pain dropped from a preoperative score of 7.5 ± 0.9 to a final follow-up score of 2.5 ± 1.2 (p < 0.001). The final outcome according to the modified Macnab criteria was excellent in 5 patients (23.8%), good in 12 (57.2%), fair in 4 (19.0%), and poor in 0. Therefore, excellent or good results (a satisfied outcome) were obtained in 80.9% of the patients. Complications were limited to one dural tear (4.8%). The authors found that the extraforaminal approach of BESS was a feasible and advantageous endoscopic technique for the treatment of foraminal lesions, including stenosis and disc herniation. They suggest that this technique represents a useful, alternative, minimally invasive method that can be used to treat lumbar foraminal stenosis and disc herniation.
本研究旨在描述双门内镜脊柱手术（BESS）的椎间孔外入路，作为一种用于经椎间孔减压和椎间盘切除术的新内镜技术，并首次展示该新手术的临床效果。根据纳入和排除标准，纳入了2015年3月至2016年4月间接受BESS椎间孔外入路手术的21例患者（27个节段）。记录手术时间（分钟/节段）及术后并发症。采用视觉模拟量表（VAS）评分，评估术前及末次随访时下肢根性疼痛程度。采用改良Macnab标准评估末次随访时的临床效果。随访期平均时长为14.8个月（最短时长12个月）。单节段平均手术时间为96.7分钟。下肢根性疼痛的平均VAS评分从术前的7.5±0.9降至末次随访时的2.5±1.2（p<0.001）。根据改良Macnab标准，最终结果为优的有5例患者（23.8%），良的有12例（57.2%），可的有4例（19.0%），差的为0例。因此，80.9%的患者获得了优或良的结果（满意的结局）。并发症仅限于1例硬膜撕裂（4.8%）。作者发现，BESS的椎间孔外入路是一种治疗椎间孔病变（包括狭窄和椎间盘突出）的可行且有利的内镜技术。他们认为，该技术是一种有用的、可替代的微创方法，可用于治疗腰椎椎间孔狭窄和椎间盘突出。
