Ahn Yong, Lee Uhn, Lee Yong Jae, Keum Han Joong
1 Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine , Incheon, South Korea .
2 Department of Neurosurgery, Wooridul Spine Hospital , Seoul, South Korea .
Photomed Laser Surg. 2018 Oct;36(10):555-561. doi: 10.1089/pho.2018.4497. Epub 2018 Sep 21.
Laser-assisted paraspinal microdiscectomy for far lateral lumbar disc herniation (LDH) enables direct access to the foraminal or far lateral zone with minimal tissue injury and preserves facet joints, thereby preventing postoperative segmental instability. We demonstrated the clinical outcomes of this technique and discussed the pros and cons of laser use in lumbar disc surgery.
The microdiscectomy technique for L5-S1 far lateral zone may be difficult due to the limited surgical field with narrowed disc space, hypertrophied facet, and sacral ala. Thus, we used carbon dioxide (CO) laser for sophisticated decompression.
Eighty-four patients who were treated with microdiscectomy for far lateral LDH at the L5-S1 level were evaluated. Among them, 40 patients were treated using CO laser-assisted microdiscectomy, and the remaining 44 patients using conventional microdiscectomy. Perioperative and postoperative data were compared between the two groups with 2 years of follow-up. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry disability index (ODI), and modified Macnab criteria.
VAS and ODI significantly improved in both groups. An excellent or good outcome was rated in 80% and 77.3% of the laser and conventional group, respectively. There was no significant difference in global outcomes. However, hospital stay and time to return to work were significantly shorter in the laser group (p < 0.05).
CO laser-assisted paraspinal microdiscectomy is effective for treating far lateral LDH. The pinpoint laser scalpel enables delicate and complete decompression in a limited surgical field with minimal tissue trauma.
激光辅助下椎旁显微椎间盘切除术治疗极外侧腰椎间盘突出症（LDH）能够在对组织损伤最小的情况下直接进入椎间孔或极外侧区域，并保留小关节，从而预防术后节段性不稳定。我们展示了该技术的临床疗效，并讨论了激光在腰椎间盘手术中应用的优缺点。
由于手术视野有限，椎间盘间隙变窄、小关节肥大以及骶骨翼的存在，L5-S1极外侧区域的显微椎间盘切除术可能具有挑战性。因此，我们使用二氧化碳（CO）激光进行精细减压。
对84例行L5-S1水平极外侧LDH显微椎间盘切除术的患者进行评估。其中，40例患者采用CO激光辅助显微椎间盘切除术治疗，其余44例患者采用传统显微椎间盘切除术治疗。对两组患者进行为期2年的随访，并比较围手术期和术后数据。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和改良Macnab标准评估临床疗效。
两组患者的VAS和ODI均显著改善。激光组和传统组分别有80%和77.3%的患者获得了优良结果。总体疗效无显著差异。然而，激光组的住院时间和恢复工作时间明显更短（p < 0.05）。
CO激光辅助椎旁显微椎间盘切除术治疗极外侧LDH有效。精确的激光手术刀能够在有限的手术视野内实现精细且彻底的减压，同时使组织创伤最小化。
