Ning Cong, Wang Yuanyi, Xu Feng, Zhang Wenjing, Liu Wei, Lv Zhenshan, Liu Yadong, Fu Changfeng
Department of Spine Surgery, The First Hospital of Jilin University.
Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun, People's Republic of China.
Medicine (Baltimore). 2018 Nov;97(48):e13373. doi: 10.1097/MD.0000000000013373.
The accurate and smooth establishment of a working cannula guarantees rapid and minimally invasive treatment effects using percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH). With anatomic variations such as a hyperplastic superior articular process (SAP), the conventional transforaminal approach cannot achieve an ideal result.
A 48-year-old male patient suffered waist and left lower limb pain, with exacerbation of symptoms after exertion.
L5-S1 disc herniation, hyperplastic SAP of S1.
To demonstrate the segment responsible for compression, a lumbar nerve root block was carried out. This was followed by PELD via a transfacet joint approach at L5-S1.
The patient experienced an improved quality of life postoperatively (i.e., visual analog score for pain = 1 and Oswestry disability index = 88). Lumbar function and stability were preserved as of the 1-month postoperative follow-up.
The transfacet joint approach could extend the indications for PELD and present an alternative option in selected cases. A new concept of "subsidence foramen" is raised to characterize this anatomic variation, and it may guide working access establishment of PELD. In addition, reading imaging results carefully and individualizing treatments promote the use of PELD as minimally invasive surgery.
准确且顺利地建立工作通道可确保经皮内镜下腰椎间盘切除术（PELD）治疗腰椎间盘突出症（LDH）能快速取得微创治疗效果。对于存在诸如上关节突增生等解剖变异的情况，传统的经椎间孔入路无法达到理想效果。
一名48岁男性患者出现腰部及左下肢疼痛，劳累后症状加重。
L5-S1椎间盘突出症，S1上关节突增生。
为明确造成压迫的节段，进行了腰神经根阻滞。随后通过L5-S1经关节突关节入路实施PELD。
患者术后生活质量得到改善（即疼痛视觉模拟评分=1，Oswestry功能障碍指数=88）。术后1个月随访时腰椎功能及稳定性得以保留。
经关节突关节入路可扩大PELD的适应证范围，并为特定病例提供一种替代选择。提出了“下沉椎间孔”这一新概念来描述这种解剖变异，它可能指导PELD工作通道的建立。此外，仔细研读影像结果并个体化治疗有助于推动PELD作为微创手术的应用。
