Kaneko Takeshi, Iwai Hiroki, Takano Yuichi
Spine Surgery, Inanami Spine and Joint Hospital, Tokyo, JPN.
Spine Surgery, Iwai Orthopedic Medical Hospital, Tokyo, JPN.
Cureus. 2023 May 5;15(5):e38594. doi: 10.7759/cureus.38594. eCollection 2023 May.
A 79-year-old woman was presented to our hospital with L3 radiculopathy due to excessive osteophyte formation following an osteoporotic vertebral compression fracture (OVCF). She underwent a unilateral biportal endoscopy (UBE)-assisted canal decompression via the interlaminar approach. The operation time was 101 minutes. Good results were observed at one-year postoperatively. We found that UBE may be useful to avoid the risks of facetectomy, especially when decompressing narrow interlaminar spaces after upper lumbar compression fractures. Improvement of radiculopathy after lumbar compression fractures remains challenging because the upper lumbar vertebrae are often affected by compression fractures. Even in normal cases, the interlaminar space can be narrow; furthermore, the space becomes narrower after compression fractures due to vertebral body collapse. When there is compression of the posterior wall nerve root due to thickening of the yellow ligament and posterior wall damage, decompression is needed to obtain a sufficient working space. With the UBE technique, the endoscope and portals are independent of each other, and the field of view and instrument can be moved separately. Therefore, in the upper lumbar spine with a narrow interlaminar space following OVCF, decompression can be achieved while avoiding the risk of facetectomy and is unnecessary if its purpose is to secure a field of view. This report presents a case where UBE was useful to improve the effectiveness of spinal decompression in a narrow interlaminar space to treat residual neurological symptoms.
一名79岁女性因骨质疏松性椎体压缩骨折（OVCF）后骨赘过度形成导致L3神经根病，前来我院就诊。她接受了经椎板间隙入路的单侧双通道内镜（UBE）辅助椎管减压术。手术时间为101分钟。术后一年观察到良好效果。我们发现UBE可能有助于避免椎板切除术的风险，尤其是在上腰椎压缩骨折后减压狭窄的椎板间隙时。腰椎压缩骨折后神经根病的改善仍然具有挑战性，因为上腰椎椎体经常受到压缩骨折的影响。即使在正常情况下，椎板间隙也可能狭窄；此外，由于椎体塌陷，压缩骨折后间隙会变得更窄。当由于黄韧带增厚和后壁损伤导致后壁神经根受压时，需要进行减压以获得足够的工作空间。使用UBE技术时，内镜和通道相互独立，视野和器械可以分别移动。因此，在OVCF后椎板间隙狭窄的上腰椎，减压可以在避免椎板切除术风险的情况下实现，如果目的是确保视野则没有必要。本报告介绍了一例UBE有助于提高狭窄椎板间隙脊柱减压效果以治疗残留神经症状的病例。
