Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Oper Neurosurg (Hagerstown). 2022 Jul 1;23(1):67-73. doi: 10.1227/ons.0000000000000231. Epub 2022 Apr 29.
Increasingly there is an impetus on the part of surgeons to find more minimally invasive approaches to treat spinal pathologies. Retroperitoneal prepsoas and transpsoas approaches to the lumbar spine are one such example gaining increased attention. Endoscope-assisted approaches may help further reduce soft tissue dissection.
To describe an endoscope-assisted lateral retroperitoneal prepsoas approach for lumbar diskectomy.
Two fresh-frozen thoracolumbar cadaveric specimens were obtained and placed in the right lateral decubitus position. Using a left-sided, retroperitoneal prepsoas approach to the lumbar spine and under endoscopic visualization, diskectomies were performed at the L2/3, L3/4, L4/5, and L5/S1 intervertebral spaces. Qualitative assessment of the extent of central and contralateral foraminal decompression was performed.
The endoscope was found to provide effective visualization at all disk spaces and combined with the anterior retroperitoneal prepsoas approach allowed for effective decompression of all explored disk spaces. Both operators noted difficulty obtaining visualization of the ipsilateral foramen, but adequate central and contralateral foraminal decompression was achievable for central, paracentral, and contralateral far lateral disk protrusions.
Endoscope assistance may improve visualization of the lumbar intervertebral disk spaces during retroperitoneal prepsoas approaches and thereby help to expand the surgical indication for anterior and oblique lumbar interbody fusion.
外科医生越来越热衷于寻找更微创的方法来治疗脊柱疾病。腹膜后腰大肌前和腰大肌间入路治疗腰椎疾病就是一个受到越来越多关注的例子。内窥镜辅助入路可能有助于进一步减少软组织解剖。
描述一种用于腰椎间盘切除术的内窥镜辅助侧腹膜后腰大肌前入路。
获得两个新鲜冷冻的胸腰椎尸体标本，并置于右侧侧卧位。使用左侧腹膜后腰大肌前路，在内窥镜可视化下，在 L2/3、L3/4、L4/5 和 L5/S1 椎间进行椎间盘切除术。对中央和对侧椎间孔减压的程度进行定性评估。
发现内窥镜在所有椎间盘间隙都提供了有效的可视化效果，并且与前腹膜后腰大肌前路结合使用，可以有效地对所有探查的椎间盘间隙进行减压。两位操作者都注意到对侧椎间孔的可视化存在困难，但对于中央、旁中央和对侧远外侧椎间盘突出，都可以实现充分的中央和对侧椎间孔减压。
内窥镜辅助可能会改善腹膜后腰大肌前路治疗腰椎间盘间隙时的可视化效果，从而有助于扩大前路和斜侧腰椎椎间融合术的手术适应证。
