Department of Orthopaedics, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, China.
Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Medicine (Baltimore). 2024 Sep 27;103(39):e39763. doi: 10.1097/MD.0000000000039763.
Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing.
A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH.
The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge.
This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device.
This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH.
This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.
腰椎间盘突出症（LDH）表现形式多样。如果核髓或终板组织突出，环形撕裂的位置也会有所不同，这给环形缝合技术带来了各种挑战。位于椎体边缘（头侧或尾侧）的环形附着区撕裂被认为是环形缝合极具挑战性的区域。
一位 37 岁女性，逐渐出现症状，在就诊前 1 年出现左腿疼痛和麻木，疼痛放射至左腿 S1 皮区。尽管接受了超过 6 个月的连续药物治疗，但她的症状没有改善。左侧踝关节和大脚趾的跖屈肌力评分为 4 分（满分 5 分）。直腿抬高和加强试验左侧均为阳性。腰椎 CT 和磁共振成像显示 L5-S1 水平左侧椎间盘突出，神经根受压，确诊为 LDH。
术前印象为 LDH，术中证实椎体边缘环形附着区撕裂。
该患者采用关节镜辅助单通道脊柱手术（AUSS）技术治疗，重点是保留黄韧带（LF），切除突出的核髓，减压神经根，然后使用 Smile 缝合装置的骨锚定环形缝合线缝合椎缘撕裂。
术后疼痛和麻木、视觉模拟评分和日本矫形协会评分均显著改善。未观察到术后不稳定或并发症，CT 和磁共振成像证实完全减压。据我们所知，这是首例采用 AUSS 联合 LF 保留和骨锚定环形缝合技术治疗 LDH 的病例。
本病例研究表明，AUSS 联合 LF 保留和骨锚定环形缝合技术可获得良好的临床和影像学结果，是治疗 LDH 的一种安全有效的技术。
