Hirayama Jiro, Hashimoto Masayuki
Department of Orthopaedic and Spine Surgery, Seikei-kai Chiba Medical Center, Chiba, Japan.
J Neurol Surg A Cent Eur Neurosurg. 2019 Mar;80(2):88-95. doi: 10.1055/s-0038-1673399. Epub 2018 Dec 24.
With effective preoperative planning, percutaneous endoscopic diskectomy (PED) via an interlaminar approach (PED-IL) can reduce the need for partial laminectomy. Our aim was to assess the clinical outcomes of PED-IL, planned using three-dimensional fusion of computed tomography and magnetic resonance (3D CT/MR) images.
Our retrospective analysis was based on data from 102 patients (66 were men) treated by PED-IL. Preoperative planning was based on the positional relationship between the nerve root and the lumbar disk herniation, visualized on 3D CT/MR fusion images through a simulated IL window. Two approaches were planned: type I, via a partial window opening of the ligamentum flavum, and type II, via a partial IL window opening and partial laminectomy. Decisions were then made to approach the herniation from the shoulder (subtype s) or axillary (subtype a) portion of the nerve, or we used a combination of both approaches (subtype a + s). Operative time and the pre- to postsurgical change in pain and pain-related disability scores (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores) were evaluated. The number of cases in which the preoperative planned surgery was modified intraoperatively and the incidence of complications were also evaluated.
A type I approach was planned in 30 cases (29.4%) and type II in 72 cases (70.6%). Intraoperative change from type I to type II was required in two cases. The mean operative time was longer for type II than type I procedures. Pain and pain-related disability scores improved in all patients, and only one case of dural sleeve damage was identified.
Preoperative planning using a simulated IL window to visualize the 3D regional anatomy is effective in predicting the feasibility of a PED-IL.
通过有效的术前规划，经椎间孔入路的经皮内镜椎间盘切除术（PED-IL）可减少部分椎板切除术的需求。我们的目的是评估使用计算机断层扫描和磁共振三维融合（3D CT/MR）图像进行规划的PED-IL的临床效果。
我们的回顾性分析基于102例接受PED-IL治疗的患者（66例男性）的数据。术前规划基于神经根与腰椎间盘突出症之间的位置关系，通过模拟椎间孔窗口在3D CT/MR融合图像上可视化。计划了两种入路：I型，通过部分黄韧带开窗；II型，通过部分椎间孔窗口开窗和部分椎板切除术。然后决定从神经的肩部（亚型s）或腋部（亚型a）部分接近突出物，或者我们使用两种方法的组合（亚型a + s）。评估手术时间以及术前至术后疼痛和疼痛相关残疾评分（日本骨科协会背痛评估问卷评分）的变化。还评估了术中改变术前计划手术的病例数和并发症发生率。
计划I型入路30例（29.4%），II型入路72例（70.6%）。2例患者术中需要从I型改为II型。II型手术的平均手术时间比I型手术长。所有患者的疼痛和疼痛相关残疾评分均有所改善，仅发现1例硬脊膜袖损伤。
使用模拟椎间孔窗口可视化3D区域解剖结构的术前规划可有效预测PED-IL的可行性。
