Li Z Z, Zhao H L, Cao Z, Shang W L, Hou S X
Department of Orthopaedics, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 4;100(4):279-285. doi: 10.3760/cma.j.issn.0376-2491.2020.04.008.
To study the technical notes and clinical efficacy of full-endoscopic thoracic intervertebral discectomy via transforaminal approach. We included 16 patients with thoracic disc herniation treated by full-endoscopic thoracic discectomy via transforaminal approach between January 2017 and September 2018 in ours department of orthopedics. The average age is 53.7 years. The compressionare classified by nature: 5 cases of soft thoracic disc herniation, 7 cases of calcified or ossified thoracic disc herniation, and 4 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc. All patients had symptoms of thoracic myelopathy before operation, and 7 of them had radiculopathy. Via transforaminal approach under local anesthesia, enlarged foraminoplasty and full-endoscopic thoracic discectomy were used for treatment. Observe the changes of postoperative imaging, pain symptoms and recovery of spinal cord function at 1 week, 3 months, 6 months and 1 year after operation. Back pain and radicular pain were scored with VAS, neurological function was assessed with Nurick score and mJOA score, and thoracic spine function was assessed with Oswestry disability index (ODI). All operations were successfully completed, and no intraoperative conversion of surgical methods occurred. Postoperative thoracic MRI and CT examinations of all patients showed that the spinal cord was fully decompressed without any residual compression. Back pain and radicular pain were all relieved obviously in all patients, and spinal cord function was obviously restored. Transient intercostal neuralgia occurred in 2 cases after operation, and no other surgical complications occurred. Full-endoscopic or fluoroscopic foraminoplasty and full-endoscopic thoracic discectomyvia transforaminal approach under local anesthesia is a safe and effective treatment for soft and hard thoracic disc herniation located on the ventral side of the spinal cord.
探讨经椎间孔全内镜下胸椎间盘切除术的技术要点及临床疗效。我们纳入了2017年1月至2018年9月在我院骨科采用经椎间孔全内镜下胸椎间盘切除术治疗的16例胸椎间盘突出症患者。平均年龄为53.7岁。压迫情况按性质分类：软性胸椎间盘突出症5例，钙化或骨化胸椎间盘突出症7例，病变椎间盘相邻椎体后缘骨赘突出4例。所有患者术前均有胸髓病变症状，其中7例有神经根病变。在局部麻醉下经椎间孔入路，采用扩大椎间孔成形术及全内镜下胸椎间盘切除术进行治疗。观察术后1周、3个月、6个月及1年时的影像学变化、疼痛症状及脊髓功能恢复情况。采用视觉模拟评分法（VAS）对背痛及神经根性疼痛进行评分，采用Nurick评分及改良日本骨科学会（mJOA）评分评估神经功能，采用Oswestry功能障碍指数（ODI）评估胸椎功能。所有手术均顺利完成，术中未发生手术方式转换。所有患者术后胸椎MRI及CT检查显示脊髓充分减压，无任何残余压迫。所有患者背痛及神经根性疼痛均明显缓解，脊髓功能明显恢复。术后2例出现短暂性肋间神经痛，未发生其他手术并发症。经椎间孔全内镜或透视下椎间孔成形术及局部麻醉下经椎间孔全内镜下胸椎间盘切除术是治疗脊髓腹侧软性及硬性胸椎间盘突出症的一种安全有效的方法。
