Leu H F, Schreiber A, Elsig J P, Zweifel K
University Hospital Balgrist, Zurich, Switzerland.
Bull Hosp Jt Dis. 1996;54(3):190-7.
In 1979 percutaneous intervertebral surgery was introduced as an alternative to conventional open disc surgery. In 1982, discoscopy was developed for intraoperative monitoring of the selective removal of disc tissue at the site of herniation. The indication remains restricted to subligamentous contained herniations. In a series of 240 patients with a mean follow up of 53 months, 88% reached an at least satisfactory overall outcome. Newly developed endoscopic instrumentation demonstrate promising results for their use in the spinal canal as well as in the extradiscal spinal area. Since 1988, by means of new, specially adapted instrumentation, endoscopically controlled interbody fusion was introduced with temporary pedicular external fixation. In a series of 35 cases with monosegmental percutaneous fusion, at a mean follow-up of 25 months, the fusion rate--including initial pitfalls-- reached 29/35 (83%). The technique does not require blood transfusions, no remaining internal fixation is left. This minimally invasive approach facilitates functional rehabilitation. Some of the techniques presented in this article concerning percutaneous external fixation and percutaneous interbody fusion must be considered as experimental according to American FDA standards.
1979年，经皮椎间手术作为传统开放性椎间盘手术的替代方法被引入。1982年，椎间盘镜被开发用于在椎间盘突出部位对选择性切除椎间盘组织进行术中监测。其适应症仍局限于韧带下包容性椎间盘突出。在一组240例平均随访53个月的患者中，88%的患者获得了至少满意的总体结果。新开发的内镜器械在椎管以及椎间盘外脊柱区域的应用显示出了有前景的结果。自1988年以来，通过新的、特别适配的器械，采用临时椎弓根外固定引入了内镜控制下的椎间融合术。在一组35例单节段经皮融合的病例中，平均随访25个月，融合率（包括最初的问题）达到29/35（83%）。该技术不需要输血，也没有残留内固定。这种微创方法有助于功能康复。根据美国食品药品监督管理局（FDA）的标准，本文介绍的一些关于经皮外固定和经皮椎间融合的技术必须被视为实验性的。
