Harborview Medical Center, Department of Neurological Surgery, University of Washington, 325 Ninth AVE, Seattle, WA, 98104, USA.
Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
Eur Spine J. 2023 Aug;32(8):2709-2716. doi: 10.1007/s00586-023-07698-1. Epub 2023 May 11.
Surgical management of far lateral disc herniations remains challenging. Current transforaminal full-endoscopic approaches require non-visualized docking in the Kambin's triangle and have been associated with significant risk of inadvertent nerve injury. We develop a full-endoscopic approach based on reliable bony landmarks allowing for visualization of the exiting nerve root prior to the far lateral discectomy.
The surgical details of a full-endoscopic trans-pars interarticularis approach for far lateral discectomy are described. These descriptions include high quality intraoperative images and important surgical pearls. A small patient cohort is presented to demonstrate feasibility and safety of the procedure.
We demonstrate the feasibility of this approach in 14 patients with a mean age of 59.5 ± 14.7 years. At a mean follow up of 21.9 ± 6.8 months, improvement of the visual analogue scale (VAS) for leg pain was 4.3 ± 1.0 resulting in minimally clinically important difference in 78.6% of the patients. The mean improvement in VAS for the back pain was 2.6 ± 0.8 and for Oswestry disability index (ODI) was 20.6 ± 5.3. Nuances of the trans-pars surgical techniques are presented in a patient with a right-sided L4-5 far lateral disc herniation. Preoperative imaging studies, steps of the surgical progression, and intraoperative views are described in detail.
Using the pars interarticularis as the bony target area allows for safe visualized access to the extraforaminal compartment of the exiting nerve root. This novel surgical technique has the potential benefit of decreasing inadvertent neural injury and subsequent postoperative dysesthesias.
远外侧椎间盘突出的手术治疗仍然具有挑战性。目前的经椎间孔全内镜方法需要在 Kambin 三角进行不可视的对接，并且与无意中损伤神经的风险显著相关。我们开发了一种基于可靠的骨性标志的全内镜方法，允许在进行远外侧椎间盘切除术前观察到神经根的出口。
描述了一种用于远外侧椎间盘切除的全内镜经关节突间入路的手术细节。这些描述包括高质量的术中图像和重要的手术要点。提出了一个小患者队列，以证明该手术的可行性和安全性。
我们在 14 名平均年龄为 59.5±14.7 岁的患者中证明了该方法的可行性。在平均 21.9±6.8 个月的随访中，腿部疼痛的视觉模拟评分（VAS）改善了 4.3±1.0，78.6%的患者有最小的临床重要差异。背部疼痛的 VAS 平均改善了 2.6±0.8，Oswestry 功能障碍指数（ODI）改善了 20.6±5.3。在一名右侧 L4-5 远外侧椎间盘突出的患者中介绍了经关节突手术技术的细微差别。详细描述了术前影像学研究、手术进展的步骤和术中视图。
使用关节突间作为骨性靶区，可以安全地可视化进入神经根的椎间孔外间隙。这种新的手术技术有可能减少意外的神经损伤和随后的术后感觉异常。
