Shea M, Takeuchi T Y, Wittenberg R H, White A A, Hayes W C
Department of Orthopaedic Surgery, Charles A. Dana Research Institute, Beth Israel Hospital, Boston, MA 02215.
J Spinal Disord. 1994 Aug;7(4):317-25.
Diskectomy, chemonucleolysis, percutaneous diskectomy, and laser ablation are used to treat patients with sciatica. The effects of percutaneous diskectomy on the intradiscal pressure of the human disk are not known. Our aims were to determine (a) whether removal of nucleus through automated percutaneous diskectomy significantly reduces intradiscal pressure without altering the disk geometry and stiffness, and if so, how much nucleus removal is required to achieve these goals; and (b) whether the effects of conventional diskectomy on these same parameters are equivalent to removal of nucleus through automated percutaneous diskectomy. Cyclic compressive loads of 20-900 N were applied to lumbar disks. Conventional diskectomy or automated percutaneous diskectomy (performed for 40 min with biomechanical measurements made four times at 10-min intervals) was then performed under zero load and the specimens retested under the same cyclic compressive loading. There were significant (p < 0.01) decreases in intradiscal pressure (by 7% under 900 N) after 10 min of automated percutaneous lumbar diskectomy. There were no further significant decreases in pressure during the next 30 min of percutaneous diskectomy. There were also significant decreases in pressure due to a puncture hole made with the Nucleotome trephine alone, without removal of disk material, and there was no difference in pressure after trephining alone and after percutaneous diskectomy. Decreases in disk height were significant, ranging from 5% at 10 min to 7% at 40 min of treatment. There were equivalent decreases in intradiscal pressure and disk height due to removal of similar amounts of nucleus during conventional diskectomy and during 40 min of percutaneous diskectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
椎间盘切除术、化学髓核溶解术、经皮椎间盘切除术和激光消融术用于治疗坐骨神经痛患者。经皮椎间盘切除术对人体椎间盘内压力的影响尚不清楚。我们的目的是确定：(a) 通过自动经皮椎间盘切除术去除髓核是否能在不改变椎间盘几何形状和硬度的情况下显著降低椎间盘内压力，如果可以，需要去除多少髓核才能实现这些目标；(b) 传统椎间盘切除术对这些相同参数的影响是否等同于通过自动经皮椎间盘切除术去除髓核。对腰椎间盘施加20 - 900 N的循环压缩载荷。然后在零载荷下进行传统椎间盘切除术或自动经皮椎间盘切除术（持续40分钟，每隔10分钟进行四次生物力学测量），并在相同的循环压缩载荷下对标本重新测试。自动经皮腰椎间盘切除术10分钟后，椎间盘内压力显著降低（在900 N时降低7%，p < 0.01）。在接下来的30分钟经皮椎间盘切除术中，压力没有进一步显著降低。仅用髓核切割器环钻打孔而不去除椎间盘材料也会导致压力显著降低，仅环钻后和经皮椎间盘切除术后的压力没有差异。椎间盘高度降低显著，治疗10分钟时为5%，40分钟时为7%。在传统椎间盘切除术和40分钟经皮椎间盘切除术中，由于去除相似量的髓核，椎间盘内压力和椎间盘高度的降低是等效的。（摘要截断于250字）
