Pain Medicine Center and Department of Orthopedics, Peking University Third Hospital, Beijing, China.
Peking University Third Hospital, Beijing, China.
Pain Physician. 2018 Jul;21(4):E355-E365.
Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated.
To investigate a 3D method and quantitatively evaluate the trajectory for percutaneous endoscopic lumbar discectomy (PELD).
Technical note.
Pain medicine center of a university hospital.
Twenty patients suffering from L4/5 disc herniation were enrolled in this study. After reconstructing the preoperative CT images, the virtual trajectory was placed into the intervertebral foramen through gradient-changing angulations in relation to the coronal and transverse planes. The overlapping portion of the virtual trajectory and the lumbar vertebrae was evaluated. In addition, the probability of atypical structure involvement was calculated.
As cephalad angulation (CA) increased, the intersection volume of the L4 inferior articular process increased, while the total intersection volume, the intersection volume of the L5 superior articular process, the intersection volume of the facet joint, and the volume proportion of L5 superior articular process intersection in the facet joint all decreased. As coronal plane angulation (CPA) increased, the total intersection volume, the intersection volume of the L4 inferior articular process, and the intersection volume of the facet joint all increased, while the volume proportion of the L5 superior articular process intersection in the facet joint decreased. When CA increased to 15°-20°, there was a high probability of atypical structure involvement, whereas such a probability in the groups of CA 0° (CPA 15°, 20°, and 25°), CA 5° and CA 10° was low.
Only patients with L4/5 herniation were evaluated in this study.
In terms of the regularity, the ideal angulation for L4/L5 PELD is CPA 5°-10° and CA 5°-10°, which can lead to a relatively low level of total damage to the bony structure, minimal damage to the facet joint, and negligible involvement of atypical structures.
Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction.
经皮内窥镜腰椎间盘切除术（PELD）已成为一种日益流行的微创脊柱手术。由于 PELD 的技术发展，减压的焦点已从中央核转移到环形突出的椎间盘突出，这允许直接进行神经减压。手术进入椎管会导致骨结构阻塞的可能性更大，因此工作通道的位置和方向至关重要。现有的术前测量方法主要依赖于二维（2D）x 射线图像或 MRI 横断面。由于骨结构和轨迹是三维（3D）的，因此无法精确评估解剖腰椎结构与工作通道之间的关系。
研究一种 3D 方法并定量评估经皮内窥镜腰椎间盘切除术（PELD）的轨迹。
技术说明。
大学医院疼痛医学中心。
本研究纳入了 20 例 L4/5 椎间盘突出症患者。在重建术前 CT 图像后，通过与冠状面和横断面成梯度变化的角度将虚拟轨迹放置到椎间孔中。评估虚拟轨迹与腰椎重叠的部分。此外，还计算了非典型结构受累的概率。
随着头向角（CA）的增加，L4 下关节突的交叉容积增加，而总交叉容积、L5 上关节突的交叉容积、关节突关节的交叉容积以及关节突关节中 L5 上关节突的交叉容积比例均减少。随着冠状面角（CPA）的增加，总交叉容积、L4 下关节突的交叉容积和关节突关节的交叉容积均增加，而关节突关节中 L5 上关节突的交叉容积比例减少。当 CA 增加到 15°-20°时，非典型结构受累的概率较高，而 CA 0°（CPA 15°、20°和 25°）、CA 5°和 CA 10°组的这种概率较低。
本研究仅评估了 L4/5 疝患者。
就规律性而言，L4/L5 PELD 的理想角度为 CPA 5°-10°和 CA 5°-10°，这可以导致相对较低水平的总骨结构损伤、最小化对关节突关节的损伤以及可忽略不计的非典型结构受累。
腰椎间盘突出症、经皮内窥镜腰椎间盘切除术（PELD）、经椎间孔、轨迹、3D 方法、定量测量、角度、骨结构阻塞。
