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关节镜辅助下单通道脊柱手术联合改良单侧椎板切开双侧减压治疗腰椎硬膜外脂肪增多症:病例报告及新治疗方法

Arthroscopic-assisted uni-portal spinal surgery combined with modified unilateral laminotomy with bilateral decompression for the treatment of lumber epidural lipomatosis: Case report and new therapeutic method.

作者信息

Li Yongneng, Qian Fei, Sun Fei, Song En

机构信息

Spine Surgery, The Second People's Hospital of Qujing, Yunnan, China.

Orthopedics and Traumatology Department, Luliang County Traditional Chinese Medicine Hospital, Yunnan, China.

出版信息

J Orthop. 2024 Jul 5;58:90-95. doi: 10.1016/j.jor.2024.07.003. eCollection 2024 Dec.

Abstract

BACKGROUND

Lumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by the pathological proliferation of adipose tissue in the epidural space of the spinal canal. This study presents the case of a 59-year-old male with lumbar SEL treated effectively in the short term through arthroscopic-assisted uniportal spinal surgery (AUSS) combined with a modified circle-drawing unilateral laminotomy with bilateral decompression (ULBD) technique.

METHODS

A modified circle-drawing ULBD procedure was executed via AUSS for a patient with SEL. The procedure involved the excision of diseased adipose tissue from the spinal canal, enlargement and decompression of the spinal canal, liberation of nerves, and post-operative evaluation of imaging results and clinical outcomes.

RESULTS

The patient exhibited improvements in the dural sac cross-sectional area, low back pain Visual Analogue Score (VAS, leg pain VAS, lumbar spine Japanese Orthopaedic Association (JOA), and EQ-5D post-surgery.

CONCLUSIONS

AUSS offers comprehensive visualization, straightforward positioning, facilitating a broad field of view and precise lesion management. The modified circle-drawing ULBD technique characterized by its simplicity, operational freedom, and extensive decompression range, contributes to symptom alleviation and patient recovery.

摘要

背景

腰椎硬脊膜外脂肪增多症(SEL)是一种罕见病症,其特征为椎管硬膜外间隙脂肪组织的病理性增生。本研究介绍了一例59岁男性腰椎SEL患者,通过关节镜辅助单通道脊柱手术(AUSS)联合改良画圈单侧椎板切开双侧减压(ULBD)技术在短期内得到有效治疗的病例。

方法

通过AUSS对一名SEL患者实施改良画圈ULBD手术。该手术包括从椎管切除病变脂肪组织、扩大椎管并减压、松解神经以及术后对影像学结果和临床结局进行评估。

结果

患者术后硬脊膜囊横截面积、腰背痛视觉模拟评分(VAS)、腿痛VAS、腰椎日本骨科协会(JOA)评分以及EQ-5D均有改善。

结论

AUSS提供全面的可视化、定位直接,便于获得广阔视野和精确处理病变。改良画圈ULBD技术具有操作简单、操作自由度大、减压范围广的特点,有助于缓解症状和患者康复。

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