Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, South Korea.
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
World Neurosurg. 2021 Jan;145:712-721. doi: 10.1016/j.wneu.2020.06.188.
Recently, spine surgery has gradually evolved from conventional open surgery to minimally invasive surgery, and endoscopic spine surgery (ESS) has become an important procedure in minimally invasive spine surgery. With improvements in the optics, spine endoscope, endoscopic burr, and irrigation pump, the indications of ESS are gradually widening from lumbar to cervical and thoracic spine. ESS was not only used previously for disc herniations that were contained without migration but is also used currently for highly migrated disc herniations and spinal stenosis; thus, the indications of ESS will be further expanded. Although ESS has certain advantages such as less soft tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent less epidural fibrosis and scarring, reduced hospital stay, early functional recovery, and improvement of quality of life as well as better cosmesis, several obstacles remain for ESS to be widespread because it has a steep learning curve and surgical outcome is strongly dependent on the surgeon's skillfulness. A solid surgical technique requires reproducibility and ensured safety in addition to surgical outcomes. In this review article, how to improve ESS was investigated by grafting novel technologies such as navigation, robotics, and 3-dimensional and ultraresolution visualization.
近年来，脊柱外科已逐渐由传统的开放性手术向微创技术演变，而内镜脊柱外科（Endoscopic Spine Surgery，ESS）也成为微创脊柱外科中的重要术式之一。随着光学、脊柱内镜、内镜磨钻、灌流泵等的进步，ESS 的适应证已由腰椎逐渐向颈椎、胸椎扩展，ESS 不仅用于无游离的包容性椎间盘突出症，也用于高度游离的椎间盘突出症和椎管狭窄症，因此，ESS 的适应证将进一步扩大。尽管 ESS 具有软组织剥离和肌肉创伤少、出血量少、硬膜外血供损伤小、硬膜外纤维化和粘连少、住院时间短、功能恢复早、生活质量提高和美容效果好等优点，但由于其学习曲线陡峭，手术效果强烈依赖于术者的技巧，因此，ESS 要广泛开展仍存在一些障碍。扎实的手术技术除了手术效果外，还需要可重复性和安全性的保证。在这篇综述文章中，通过移植导航、机器人技术以及三维和超分辨率可视化等新技术，探讨了如何改进 ESS。
