O'Hara L J, Marshall R W
Royal Berkshire Hospital, Reading, England, UK.
J Bone Joint Surg Br. 1997 Nov;79(6):943-7. doi: 10.1302/0301-620x.79b6.7876.
Of a total of 330 patients requiring operation on a lumbar disc, 20 (6.1%) with lateral disc prolapse had a new muscle-splitting, intertransverse approach which requires minimal resection of bone. There were 16 men and 4 women with a mean age of 52 years. All had intense radicular pain, 15 had femoral radiculopathy and 19 a neurological deficit. Far lateral herniation of the disc had been confirmed by MRI. At operation, excellent access was obtained to the spinal nerve, dorsal root ganglion and the disc prolapse. The posterior primary ramus was useful in locating the spinal nerve and dorsal root ganglion during dissection of the intertransverse space. At review from six months to four years, 12 patients had excellent results with no residual pain and six had good results with mild discomfort and no functional impairment. Two had poor results. There had been neurological improvement in 17 of the 20 patients. We report a cadaver study of the anatomy of the posterior primary ramus. It is readily identifiable through this approach and can be traced down to the spinal nerve in the intertransverse space. We recommend the use of a muscle-splitting intertransverse approach to far lateral herniation of the disc, using the posterior primary ramus as the key to safe dissection.
在总共330例需要进行腰椎间盘手术的患者中，20例（6.1%）外侧椎间盘突出患者采用了新的肌肉劈开、经横突间入路，该入路所需的骨质切除最少。其中男性16例，女性4例，平均年龄52岁。所有患者均有剧烈的神经根性疼痛，15例有股神经神经根病，19例有神经功能缺损。MRI已证实为极外侧椎间盘突出。手术时，能够很好地显露脊神经、背根神经节和椎间盘突出部位。在经横突间间隙的解剖过程中，后支有助于定位脊神经和背根神经节。在术后6个月至4年的复查中，12例患者效果极佳，无残留疼痛，6例效果良好，有轻度不适但无功能障碍。2例效果不佳。20例患者中有17例神经功能得到改善。我们报告了一项关于后支解剖结构的尸体研究。通过这种入路很容易识别后支，并且可以在经横突间间隙追踪至脊神经。我们建议采用肌肉劈开经横突间入路治疗极外侧椎间盘突出，以后支作为安全解剖的关键。
