Bonaldi G, Minonzio G, Belloni G, Dorizzi A, Fachinetti P, Marra A, Goddi A
Department of Neuroradiology, Ospedale di Circolo e Fondazione E. e S. Macchi, Varese, Italy.
Neuroradiology. 1994 Aug;36(6):483-6. doi: 10.1007/BF00593690.
We assessed the feasibility of percutaneous treatment of a cervical herniated disc. In the lumbar region, the surgical instrument for percutaneous diskectomy passes only through the paravertebral muscles, while in the cervical region there is considerable risk of nervous, parenchymal and vascular lesions. Moreover, open surgery for cervical herniated nucleus pulposus is a well-established, low-risk procedure, with little risk of epidural fibrosis, the main complication of lumbar open surgery; a percutaneous procedure should therefore have a low morbidity rate. A safe percutaneous approach to cervical discs could be useful for biopsy and for treatment of high-risk patients for general anaesthesia. We treated 15 patients with cervical herniated nucleus pulposus; all gave informed consent and refused or were not eligible for open surgery. We used the Nucleotome described for treatment of lumbar herniated discs; except for the first three cases, we used colour Doppler sonography to detect hazardous structures in the path of the probe. We had one complication, a cervical haematoma due to damage to the inferior thyroid artery, prior to the use of ultrasound.
我们评估了经皮治疗颈椎间盘突出症的可行性。在腰椎区域，经皮椎间盘切除术的手术器械仅穿过椎旁肌肉，而在颈椎区域，存在神经、实质和血管损伤的较大风险。此外，颈椎间盘突出症的开放手术是一种成熟的、低风险的手术，硬膜外纤维化的风险很小，硬膜外纤维化是腰椎开放手术的主要并发症；因此，经皮手术的发病率应该较低。一种安全的经皮颈椎间盘治疗方法可能对活检以及对全身麻醉高风险患者的治疗有用。我们治疗了15例颈椎间盘突出症患者；所有患者均签署了知情同意书，拒绝或不符合开放手术的条件。我们使用了描述用于治疗腰椎间盘突出症的髓核切割器；除了前三例，我们使用彩色多普勒超声检测探头路径中的危险结构。在使用超声之前，我们发生了一例并发症，即由于甲状腺下动脉损伤导致的颈部血肿。
