Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.
Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
J Clin Neurosci. 2020 May;75:62-65. doi: 10.1016/j.jocn.2020.03.029. Epub 2020 Mar 26.
Foraminal disc herniation presents with an operative challenge, as it often requires facetectomy, which can result in segmental instability. The intraforaminal approach includes partial pars resection and medial facetectomy and allows for direct visualization of the nerve roots and herniated disc in the foramen without violating the joint, with good clinical outcomes. Herein, we describe a retrospective series of patients that underwent minimally invasive paramedian approach with hemilaminectomy, partial medial pars resection, medial facetectomy for foraminal disc herniation. Demographics and clinical outcomes were obtained from medical records. Improvement in functional outcomes was evaluated using the pre and post-operative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). A total of 23 patients were included in this study. The average age was 56.47 ± 9.4 yrs and body mass index was 31.92 ± 7.7 kg/m. 47.8% of cases were L4-5 FDH. The estimated blood loss was 31.32 ± 19.8 ml. The average length of hospital stay was 1.11 ± 0.3 days. All patients were discharged home. Overall, there was a significant improvement in the VAS (pre-op: 8.21 ± 2.1; post-op: 2.59 ± 2.7; p-value: <0.0001) and ODI (pre-op: 57.16 ± 13.2; post-op: 21.47 ± 9.9; p-value: <0.0001). The minimally invasive paramedian approach provides satisfactory outcomes as a safe strategy in the treatment of foraminal disc herniation. Herein, there was a significant improvement in pain and functional outcomes, minimal blood loss and decreased hospital stay.
椎间孔型椎间盘突出症具有手术治疗的挑战性，因为它通常需要关节突切除术，这可能导致节段性不稳定。经椎间孔入路包括部分椎板切除术和内侧关节突切除术，可在不侵犯关节的情况下直接观察神经根和椎间孔内的椎间盘突出，临床效果良好。在此，我们描述了一组接受微创旁正中入路伴半椎板切除术、部分内侧椎板切除术和内侧关节突切除术治疗椎间孔型椎间盘突出症的回顾性系列患者。从病历中获得人口统计学和临床结果。使用术前和术后视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）评估功能结果的改善。本研究共纳入 23 例患者。平均年龄为 56.47±9.4 岁，体重指数为 31.92±7.7kg/m。47.8%的病例为 L4-5 椎间孔型椎间盘突出症。估计失血量为 31.32±19.8ml。平均住院时间为 1.11±0.3 天。所有患者均出院回家。总体而言，VAS（术前：8.21±2.1；术后：2.59±2.7；p 值：<0.0001）和 ODI（术前：57.16±13.2；术后：21.47±9.9；p 值：<0.0001）均有显著改善。微创旁正中入路是治疗椎间孔型椎间盘突出症的一种安全策略，可获得满意的结果。在此，疼痛和功能结果显著改善，失血量少，住院时间缩短。
