Epstein N E
Department of Surgery (Neurosurgery), North Shore University Hospital, New York, New York, USA.
J Spinal Disord. 1995 Oct;8(5):383-94.
In far lateral disk surgery, although total facetectomy provides the best exposure and allows for removal of medial and far lateral extruded disk fragments, the risk of instability is increased as a result of excision of the pars interarticularis, Medial facetectomy uncovers the lateral and subarticular recess and preserves stability but does not allow for proper visualization of the far lateral compartment. The isolated extraforaminal approach provides access only to far lateral sequestrated fragments and does not allow access for more medial diskectomy or decompression of associated stenosis. Combining the extraforaminal exposure with a laminotomy, hemilaminectomy, or laminectomy complements the intertransverse (ITT) approach and affords access both to lateral and to medial disk lesions and stenotic abnormalities. The advantages and disadvantages of the less popular extraforaminal, transpars, percutaneous, and anterior decompressive techniques are also assessed. No one technique of far lateral disk excision is applicable for the management of all lesions. It is more appropriate to choose the right operation for the right patient.
在极外侧椎间盘手术中，尽管全关节突切除术可提供最佳的显露，并允许切除内侧和极外侧的脱出椎间盘碎片，但由于关节突间部被切除，不稳定风险会增加。内侧关节突切除术可显露外侧和关节下隐窝并保持稳定性，但无法充分观察极外侧区域。单纯的椎间孔外入路仅能处理极外侧游离的碎片，无法进行更内侧的椎间盘切除或相关狭窄的减压。将椎间孔外显露与椎板切开术、半椎板切除术或椎板切除术相结合，可补充经横突间（ITT）入路，从而能够处理外侧和内侧的椎间盘病变以及狭窄异常。文中还评估了不太常用的椎间孔外、经关节突、经皮和前路减压技术的优缺点。没有一种极外侧椎间盘切除技术适用于所有病变。为合适的患者选择合适的手术更为恰当。
