Duke University School of Medicine, Durham, North Carolina, USA.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Oper Neurosurg (Hagerstown). 2021 Aug 16;21(3):E237. doi: 10.1093/ons/opab134.
Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.
与开放性手术相比，微创腰椎板切除术利用管状牵开器来最小化组织干扰、出血量和住院时间。在这里，我们重点介绍了一位 68 岁男性的手术治疗，包括 2 个节段的微创腰椎板切除术和 L2-L3 和 L3-L4 的椎间孔切开术。患者最初表现为治疗抵抗性下肢麻木和活动受限的症状。他的影像学检查显示冠状位脊柱侧凸和严重的腰椎中央和椎间孔狭窄，在 L2-L3 和 L3-L4 处，棘突、椎板和小关节增大。患者同意进行该手术，并同意将其影像资料公开发表。手术时患者取俯卧位，通过微创管状牵开器在旁正中方向进行椎板切开。在每个水平进行椎板切除术和椎间孔切开术，使用高速钻头和 Kerrison 咬骨钳，注意识别和保护相关的脊神经根。术后，患者报告麻木明显减轻，活动能力改善，手术切口愈合良好，明显小于开放性手术产生的切口。
