Xiang Yaoyu, Li Jizheng, Yang Xianguang, Sun Fei, Hu Xidan, Shen Tuhaopeng, Yang Jing, Ge Weiqing, Zhou Tao, Song En
Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
Department of Orthopedics, Yunnan Provincial Traditional Chinese Medicine Hospital, Kunming, Yunnan Province China.
Medicine (Baltimore). 2025 Jul 18;104(29):e42223. doi: 10.1097/MD.0000000000042223.
Lumbar disc herniation (LDH) in patients with hemophilia A (HA) presents significant surgical challenges due to elevated perioperative bleeding risks. Traditional surgical approaches may increase the likelihood of complications such as epidural hematoma and disc reherniation, necessitating innovative strategies. This report introduces arthroscopic-assisted uniportal spinal surgery (AUSS) combined with annular suturing repair and ligamentum flavum preservation as a minimally invasive approach designed to mitigate these risks and improve surgical outcomes in patients with HA.
A 20-year-old male presented with a 1-year history of lower back pain and 4 months of right leg pain and numbness, worsened by standing and walking. Magnetic resonance imaging and computed tomography revealed L5/S1 disc herniation compressing the right nerve root. The patient's history of HA extended over 19 years.
LDH at L5/S1 and HA.
The patient underwent an AUSS with annular suture repair and ligamentum flavum suspension. Intraoperatively, the herniated nucleus pulposus was excised, and the annular defect was sutured to mitigate reherniation risk. Perioperative management included factor VIII replacement to stabilize the coagulation levels.
Postoperatively, the patient experienced significant relief from symptoms. Follow-up magnetic resonance imaging at 1 and 6 months showed no recurrence of the disc herniation. The patient returned to normal activity without any complications.
This case illustrates that AUSS with annular suturing repair is a feasible and effective approach for treating LDH patients with hemophilia, offering minimal bleeding risk, and reduced recurrence of disc herniation.
由于围手术期出血风险升高，甲型血友病（HA）患者的腰椎间盘突出症（LDH）带来了重大的手术挑战。传统手术方法可能会增加诸如硬膜外血肿和椎间盘再突出等并发症的可能性，因此需要创新策略。本报告介绍了关节镜辅助单通道脊柱手术（AUSS）结合环形缝合修复和黄韧带保留术，这是一种微创方法，旨在降低这些风险并改善HA患者的手术效果。
一名20岁男性，有1年的下背部疼痛病史以及4个月的右腿疼痛和麻木症状，站立和行走时症状加重。磁共振成像和计算机断层扫描显示L5/S1椎间盘突出压迫右侧神经根。该患者的HA病史超过19年。
L5/S1椎间盘突出症和HA。
患者接受了AUSS手术，包括环形缝合修复和黄韧带悬吊。术中，切除突出的髓核，并缝合环形缺损以降低再突出风险。围手术期管理包括补充凝血因子VIII以稳定凝血水平。
术后，患者症状明显缓解。术后1个月和6个月的随访磁共振成像显示椎间盘突出未复发。患者恢复正常活动，无任何并发症。
本病例表明，AUSS结合环形缝合修复是治疗HA合并LDH患者的一种可行且有效的方法，具有最小的出血风险，并减少了椎间盘突出的复发。
