Yamaguchi Yushi, Ono Koichiro, Fukuhara Daisuke, Dezawa Akira, Majima Tokifumi
Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Meiryu-kai Dezawa Akira PED Clinic, Tokyo 214-0014, Japan.
J Pers Med. 2024 Jun 25;14(7):679. doi: 10.3390/jpm14070679.
Endoscopic lumbar discectomy (ELD) is a key advancement in minimally invasive spinal surgery, particularly for lumbar disc herniation. Interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) are the two major methods used for FED. TELD, while less familiar to spine surgeons inexperienced in endoscopic surgery, presents challenges in visualizing the dura mater, a crucial aspect for reducing surgical complications. The hand down outside-in (HDOI) technique introduced by Dezawa enhances this visualization by positioning the cannula tip dorsally on the intervertebral disc and maneuvering it between the dura mater and disc to the spinal canal's midpoint. The cannula is then flipped to directly visualize the dura mater, enabling safe removal of the prolapsed disc material. A comparative study involving 20 patients treated from April 2020 to April 2022 examined the efficacy of the HDOI technique against conventional TELD. Each group, comprising ten patients, underwent ELD for lumbar disc herniation. While both groups showed similar improvements in clinical outcomes, as assessed using the Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) for pain, the HDOI group exhibited a 100% success rate for dura mater visualization, and this rate is significantly higher than the 60% observed in the conventional TELD group. Additionally, the time required for dura mater visualization was notably shorter for the HDOI technique. These results indicate that the HDOI technique not only enhances the safety and efficacy of TELD but may also encourage its wider use in clinical settings.
内镜下腰椎间盘切除术（ELD）是微创脊柱手术的一项关键进展，尤其适用于腰椎间盘突出症。椎板间内镜下腰椎间盘切除术（IELD）和经椎间孔内镜下腰椎间盘切除术（TELD）是用于ELD的两种主要方法。TELD对于缺乏内镜手术经验的脊柱外科医生来说不太熟悉，在可视化硬脑膜方面存在挑战，而这是减少手术并发症的关键因素。Dezawa提出的由外向内（HDOI）技术通过将套管尖端置于椎间盘背侧并在硬脑膜和椎间盘之间操作使其到达椎管中点来增强这种可视化效果。然后将套管翻转以直接观察硬脑膜，从而能够安全地切除脱出的椎间盘物质。一项涉及2020年4月至2022年4月治疗的20例患者的比较研究，考察了HDOI技术与传统TELD相比的疗效。每组10例患者，均接受了针对腰椎间盘突出症的ELD。虽然使用日本骨科协会（JOA）评分和疼痛视觉模拟量表（VAS）评估时两组的临床结果改善相似，但HDOI组硬脑膜可视化成功率为100%，这一比率显著高于传统TELD组观察到的60%。此外，HDOI技术观察硬脑膜所需的时间明显更短。这些结果表明，HDOI技术不仅提高了TELD的安全性和疗效，还可能促使其在临床环境中更广泛地应用。
