MED椎间盘镜手术治疗腰椎间盘突出症神经根解剖变异

Treatment of lumbosacral nerve root anomalies under lumbar disc microendoscopic discectomy

目的探讨MED椎间盘镜手术治疗腰椎间盘突出症术中神经根解剖变异的价值。方法采用第二代经后路腰椎间盘镜系统(MED)手术治疗腰椎间盘突出症560例,术中发现16例神经根解剖变异,发生率为2.8%。按Kadish分型:Ⅱ型10例,Ⅲ型1例,Ⅳ型5例。其中腰4、5间隙突出6例,腰5骶1间隙突出9例,腰4、5及腰5骶1间隙均突出1例。16例手术均在镜下顺利完成。结果16例术后症状和体征完全消失,没有神经根损伤表现。近远期随访均未见复发。结论腰骶神经根解剖变异发生率低。MED椎间盘镜手术系统视野清晰,镜下容易分辨出突出椎间盘与神经根,对神经根解剖变异显露清楚,可以有效防止神经根损伤,避免并发症的发生。

Objective To explore the value of lumbar disc microendoscopic discectomy （MED）when the lumbosacral nerve root anomaly occurred. Methods Five hundred and sixty cases of lumbar discs herniation were treated with MED. In which 16 case of nerve root anomalies were found. The incidence was 2. 8%. There were type Ⅱ 10 cases, type Ⅲ 1 case and type Ⅳ 5 cases according to Kadish type. There were 6 cases at L4. 5, 9 cases at L5S1 and 1 cases between L4. 5 and L5S1. Sixteen cases of nerve root anomalies were operated by MED. Results No nerve root injury happened in these 16 nerve root anmalies cases post MED. Preoperative symptoms and sings disappeared and no cases of recurrence were found by follow-up. Conclusion There is a low incidence of the lumbosacral nerve mot anomalies. There is a clearly identifying under MED, it could effectively prevent the nerve root injury because of its distinct vision and adjacent relationship between protruding disc and nerve root and anomaly nerve root. There were no special complications.