Division of Neurosurgery, Santa Tereza Hospital, Campinas, São Paulo, Brazil.
Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
World Neurosurg. 2024 Jan;181:6-12. doi: 10.1016/j.wneu.2023.10.001. Epub 2023 Oct 6.
Thirty years have passed since Kambin's first clinical series of lumbar disc herniations (LDH) treated by arthroscopic microdiscectomy. Despite several advances in this interim, sequestrated LDHs over the dorsal aspect of the dura, and high-grade up- or downward disc migration have been a relative limitation of the transforaminal endoscopic technique. The interlaminar window was the next step to deal with such highly migrated LDHs. Favorable outcomes were obtained in 70-90% of the patients in the long-term, but recurrence rates remained high (approximately 12%), and the approach could be limited by the size of the interlaminar window. Few relevant studies have addressed the role of translaminar full endoscopic technique for migrated LDHs. To describe an innovative modification of the translaminar full endoscopic approach with Tom Shidi needles.
This technical modification is presented in a detailed fashion for treating these challenging LDHs and illustrated through a clinical case.
The patient underwent successful translaminar full endoscopic technique with complete pain resolution postoperatively. The postprocedural course was uneventful. A follow-up imaging showed no evidence of residual LDHs fragments.
Translaminar full endoscopic technique with Tom Shidi needles is a promising modification of the previously presented interlaminar and translaminar endoscopic routes in the treatment of migrated LDHs to fasten surgical procedures and increase the safety of spinal canal manipulation.
自 Kambin 首次开展经皮关节镜下腰椎间盘切除术（LDH）治疗腰椎间盘突出症以来，已经过去了 30 年。尽管在此期间取得了一些进展，但硬脊膜背侧游离型 LDH 和高位或低位椎间盘迁移仍然是经皮椎间孔内镜技术的相对局限性。层间窗是处理这种高度迁移型 LDH 的下一步。在长期随访中，70%-90%的患者获得了良好的结果，但复发率仍然很高（约 12%），而且该方法可能受到层间窗大小的限制。很少有相关研究探讨经皮椎间孔内镜技术治疗迁移型 LDH 的作用。本文旨在介绍一种经皮椎间孔内镜技术的创新改良方法，即使用 Tom Shidi 针。
详细介绍了这种经皮椎间孔内镜技术的改良方法，并用一个临床病例进行了说明。
患者成功接受了经皮椎间孔内镜技术治疗，术后疼痛完全缓解。术后过程顺利。随访影像学检查未见残留 LDH 碎片。
使用 Tom Shidi 针的经皮椎间孔内镜技术是对之前介绍的经皮椎间孔内镜和经皮椎间孔内镜入路治疗迁移型 LDH 的一种有前途的改良方法，可以加快手术进程并提高椎管操作的安全性。
