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文章学习：应用微创手术方法-全脊柱内窥镜治疗腰椎椎间孔狭窄所致L5神经根受压 背景：经皮内窥镜腰椎间盘切除术（PELD）是治疗腰椎间盘突出症（LDH）的一种微创的治疗方法。本研究探讨全内视镜系统治疗腰椎间孔狭窄症所致L5神经根压迫（L5-LFS）的有效性。 方法：从2016年11月到2017年12月，共有10例L5-LFS引起的单侧下肢痛患者接受了PELD全内窥镜手术治疗。双侧L5-LFS或L5-LFS合并LDH和/或腰椎滑脱（峡部裂）的患者排除本研究。使用直径为3.5mm的高速孔钻，通过同侧椎体峡部进行经皮内镜下经椎板入路（PETA）。采用改良的日本骨科协会（mJOA）评分和数值评定量表（NRS）评分评估术前和术后病情。 结果：患者平均年龄62.2岁，男性7例，女性3例。mJOA评分平均治愈率为58.2%,术前和术后NRS评分平均分别为7.4和2.3。平均手术时间为77.6分钟。虽然没有主要的并发症，但一位80岁老年女性患者合并腰椎滑脱（迈耶丁二级）的患者疼痛没有改善。 结论：全内镜下PETA治疗L5-LFS是一种安全有效的微创治疗方法，有望成为L5-S1椎体间融合的替代手术方式。 A less invasive surgery using a full-endoscopic system for L5 nerve root compression caused by lumbar foraminal stenosis Katsuhiko Ishibashi1,2, Yasushi Oshima1,2,3, Hirokazu Inoue1,2,4, Yuichi Takano1,2, Hiroki Iwai1,2, Hirohiko Inanami1,2, Hisashi Koga1,2 1Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan; 2Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan; 3Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan; 4Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan Contributions: (I) Conception and design: H Koga; (II) Administrative support: H Iwai, H Inanami; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: H Koga; (VII) Final approval of manuscript: All authors. Correspondence to: Hisashi Koga, MD, PhD. Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan. Email: hkoga0808@gmail.com. Background: Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the usefulness of a full-endoscopic system for PELD to treat L5 nerve root compression caused by lumbar foraminal stenosis (L5-LFS). Methods: Between November 2016 and December 2017, a total of 10 patients with unilateral leg pain due to L5-LFS underwent surgery using a full-endoscopic system for PELD. Patients with bilateral L5-LFS or L5-LFS with coexisting LDH and/or spondylolysis were excluded from this study. A percutaneous endoscopic translaminar approach (PETA) was performed via the ipsilateral vertebral isthmus using a 3.5-mm diameter high-speed drill. Preoperative and postoperative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) and Numerical Rating Scale (NRS) scores. Results: The patients’ mean age was 62.2 years; there were 7 male and 3 female patients. The mean recovery rate was 58.2% with the mJOA score; mean pre- and postoperative NRS scores were 7.4 and 2.3, respectively. The mean operative time was 77.6 min. Although there were no major complications, pain did not improve in an 80-year-old woman with coexisting spondylolisthesis (Meyerding grade 2). Conclusions: PETA using a full-endoscopic system is a safe and effective minimally invasive treatment for L5-LFS, with potential to be an alternative surgical strategy for L5-S1 interbody fusion. Keywords: Percutaneous endoscopic translaminar approach (PETA); lumbar foraminal stenosis (LFS); L5 nerve root compression; high-speed drill; minimally invasive Journal of spine surgery submitted Jun 05, 2018. Accepted for publication Jun 20, 2018. doi: 10.21037/jss.2018.06.18 |
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