Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
Medicine (Baltimore). 2021 Mar 19;100(11):e24220. doi: 10.1097/MD.0000000000024220.
Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH.
A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year.
Lumbar disc herniation (LDH).
This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM.
The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively.
ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.
传统的开放式椎间盘切除术和椎间融合术是治疗腰椎间盘突出症（LDH）的常用策略。然而，它存在恢复时间长和椎旁软组织损伤严重的缺点。Zina 经皮螺钉固定联合内镜下腰椎融合术（ZELIF）作为一种新型的微创治疗 LDH 的手术技术，具有恢复更快、软组织破坏更少、住院时间更短和疼痛更小的优点。我们报告了一种在术中神经监测（INM）下治疗 LDH 的新型 ZELIF 技术。
一名 51 岁男性因左下肢疼痛和麻木 1 年来我院就诊。
腰椎间盘突出症（LDH）。
该患者接受 Zina 经皮螺钉固定联合内镜下神经减压、终板准备和通过 Kambin 三角的椎间融合治疗。手术的每一步都是在 INM 下进行的。
随访期为 12 个月；住院时间为 4 晚；出血量为 65ml，手术时间为 266min。术中 INM 显示无神经损伤。在随访期间，没有观察到手术并发症，包括神经恶化、 cage 迁移、不愈合、器械失败或翻修手术。视觉模拟评分（VAS）从 7 分降至 1 分；Oswestry 功能障碍指数（ODI）从 43 分降至 14 分；EQ-5D 评分术前为 10 分，末次随访时为 15 分；36 项简短健康调查问卷（SF-36）的生理成分综合评分为 48 分，末次随访时为 49 分；SF-36 心理成分综合评分为 47 分，术后降至 41 分。
在 INM 下进行 ZELIF 可能代表一种可行、安全且有效的替代方案，用于在选定患者中直接微创减压腰椎出口神经根，同时进行椎间融合和经皮螺钉固定。
