Ishibashi Katsuhiko, Oshima Yasushi, Inoue Hirokazu, Takano Yuichi, Iwai Hiroki, Inanami Hirohiko, Koga Hisashi
Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.
J Spine Surg. 2018 Sep;4(3):594-601. doi: 10.21037/jss.2018.06.18.
Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the usefulness of a full-endoscopic system for PELD to treat L5 nerve root compression caused by lumbar foraminal stenosis (L5-LFS).
Between November 2016 and December 2017, a total of 10 patients with unilateral leg pain due to L5-LFS underwent surgery using a full-endoscopic system for PELD. Patients with bilateral L5-LFS or L5-LFS with coexisting LDH and/or spondylolysis were excluded from this study. A percutaneous endoscopic translaminar approach (PETA) was performed via the ipsilateral vertebral isthmus using a 3.5-mm diameter high-speed drill. Preoperative and postoperative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) and Numerical Rating Scale (NRS) scores.
The patients' mean age was 62.2 years; there were 7 male and 3 female patients. The mean recovery rate was 58.2% with the mJOA score; mean pre- and postoperative NRS scores were 7.4 and 2.3, respectively. The mean operative time was 77.6 min. Although there were no major complications, pain did not improve in an 80-year-old woman with coexisting spondylolisthesis (Meyerding grade 2).
PETA using a full-endoscopic system is a safe and effective minimally invasive treatment for L5-LFS, with potential to be an alternative surgical strategy for L5-S1 interbody fusion.
经皮内镜下腰椎间盘切除术（PELD）是治疗腰椎间盘突出症（LDH）的一种相对微创的方法。本研究探讨了全内镜系统在PELD治疗腰椎椎间孔狭窄（L5-LFS）所致L5神经根受压中的应用价值。
2016年11月至2017年12月，共有10例因L5-LFS导致单侧腿痛的患者接受了使用全内镜系统进行PELD的手术。双侧L5-LFS或合并LDH和/或椎弓根峡部裂的L5-LFS患者被排除在本研究之外。采用直径3.5mm的高速钻头经同侧椎弓根峡部行皮内镜下经椎板入路（PETA）。采用改良日本骨科学会（mJOA）评分和数字评分量表（NRS）对术前和术后情况进行评估。
患者平均年龄62.2岁；男性7例，女性3例。mJOA评分的平均恢复率为58.2%；术前和术后NRS评分的平均值分别为7.4和2.3。平均手术时间为77.6分钟。虽然没有严重并发症，但一名合并腰椎滑脱（Meyerding 2级）的80岁女性疼痛未改善。
使用全内镜系统的PETA是一种安全有效的L5-LFS微创治疗方法，有可能成为L5-S1椎间融合的替代手术策略。
