Xiang Hongfei, Latka Kajetan, Maste Praful, Tanaka Masato, Kumawat Chetan, Arataki Shinya, Fujiwara Yoshihiro, Taoka Takuya, Miyamoto Akiyoshi
Department of Orthopaedic Surgery, Okayama Rosai Hospital.
Department of Orthopaedic Surgery, the Affiliated Hospital of Qingdao University.
Acta Med Okayama. 2024 Dec;78(6):475-483. doi: 10.18926/AMO/67878.
This report presents a new unilateral biportal endoscopic (UBE) technique for lumbar disc herniation without C-arm guidance. Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. We here describe the use of standard intraoperative navigation in UBE to reduce radiation exposure and increase surgical accuracy. A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had had conservative treatment for 12 months in another hospital before admission, but this proved unsuccessful. On admission he had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle weakness of the bilateral legs (manual muscle testing (MMT) grade of the extensor hallucis longus: 4/4), and numbness of the bilateral lower legs. Preoperative lumbar MRI showed L4/5 large central disc herniation. He underwent C-arm free UBE discectomy under the guidance of O-arm navigation. The surgery was successful, with postoperative lumbar MRI showing good decompression of the dural sac and bilateral L5 nerve roots. The MMT grade and sensory function of both legs had recovered fully on final follow-up at one year. The new UBE technique under navigation guidance was shown to be useful for lumbar disc herniation. This innovative technique was safe and accurate for the treatment of lumbar intervertebral disc herniation, and minimized radiation exposure to surgeons.
本报告介绍了一种无需C形臂引导的新型单侧双通道内镜（UBE）治疗腰椎间盘突出症的技术。当保守治疗方法失败时，腰椎间盘突出症需要手术干预。向微创经皮内镜下腰椎间盘切除术的转变，包括单通道和双通道方法，受到陡峭的学习曲线和对辐射密集型C形臂引导的依赖等挑战的阻碍。我们在此描述在UBE中使用标准术中导航以减少辐射暴露并提高手术准确性。一名24岁男性因腰背部及双侧腿部疼痛伴步态障碍被转诊至我院。入院前他在另一家医院接受了12个月的保守治疗，但未成功。入院时他有腰背痛（视觉模拟评分法（VAS）4/10）和双侧腿痛（VAS 8/10）、双侧腿部肌肉无力（拇长伸肌手动肌力测试（MMT）等级：4/4）以及双侧小腿麻木。术前腰椎磁共振成像（MRI）显示L4/5中央型大椎间盘突出。他在O形臂导航引导下接受了无C形臂UBE椎间盘切除术。手术成功，术后腰椎MRI显示硬脊膜囊和双侧L5神经根减压良好。在一年的最终随访时，双腿的MMT等级和感觉功能已完全恢复。结果表明，导航引导下的新型UBE技术对腰椎间盘突出症有效。这种创新技术治疗腰椎间盘突出症安全且准确，并将外科医生的辐射暴露降至最低。
