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局部麻醉下清醒状态下经椎间孔全内镜腰椎间盘切除术:由内向外和由外向内技术

Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques.

作者信息

Yoshinari Haruhiko, Tezuka Fumitake, Yamashita Kazuta, Manabe Hiroaki, Hayashi Fumio, Ishihama Yoshihiro, Sugiura Kosuke, Takata Yoichiro, Sakai Toshinori, Maeda Toru, Sairyo Koichi

机构信息

Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.

出版信息

Curr Rev Musculoskelet Med. 2019 Jun 24;12(3):311-317. doi: 10.1007/s12178-019-09565-3.

Abstract

PURPOSE OF THE REVIEW

Transforaminal full-endoscopic lumbar discectomy (TELD) under local anesthesia was first introduced in Japan in 2003. Initially referred to as percutaneous endoscopic discectomy, in 2018, a consensus was reached worldwide and the preferred term is now TELD. The procedure requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. Thus, it is the least invasive disc surgery. In this review, we introduce two types of the TELD surgery.

RECENT FINDINGS

Initially, TELD was performed as the "inside-out" technique but was associated with reports of postoperative dysesthesia due to exiting nerve injury. Recently, the "outside-in" technique after foraminoplasty was proposed for safer insertion of the cannula into the disc. Foraminoplasty can widen the narrow foramen, thereby allowing the 8-mm cannula to pass through easily and safely, and thus injury to the exiting nerve root can be theoretically avoided. We described two types of the TELD in this review. Surgeons should be familiar with the inside-out and outside-in techniques for TELD; therefore, we can select appropriate technique for each case.

摘要

综述目的

经椎间孔全内镜下腰椎间盘切除术(TELD)于2003年在日本首次引入局部麻醉下进行。最初被称为经皮内镜下椎间盘切除术,2018年,全球达成共识,现在首选术语是TELD。该手术仅需8毫米的皮肤切口,对椎旁肌肉造成的损伤最小。因此,它是侵入性最小的椎间盘手术。在本综述中,我们介绍两种类型的TELD手术。

最新发现

最初,TELD作为“由内向外”技术进行,但有因出口神经损伤导致术后感觉异常的报道。最近,有人提出在椎间孔成形术后采用“由外向内”技术,以便更安全地将套管插入椎间盘。椎间孔成形术可扩大狭窄的椎间孔,从而使8毫米的套管能够轻松、安全地通过,因此理论上可避免损伤出口神经根。我们在本综述中描述了两种类型的TELD。外科医生应熟悉TELD的“由内向外”和“由外向内”技术;因此,我们可以为每个病例选择合适的技术。

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