脊柱内镜辅助斜外侧椎间融合术治疗腰椎退变性疾病

Endoscopic assisted oblique lumbar interbody fusion for lumbar degenerative diseases

[目的]探讨脊柱内镜辅助斜外侧椎间融合术(oblique lumbar interbody fusion, OLIF)治疗伴腰椎间盘突出症的腰椎退变性疾病的临床疗效和技术要点。[方法] 2016年5月～2017年8月,本院收治的15例伴腰椎间盘突出症状的腰椎退变性疾病患者,其中男7例,女8例,平均年龄(54.92±10.14)岁[(37～72)岁];术中经OLIF通道将脊柱内镜经椎间隙置入到髓核突出部位,内镜下摘除突出髓核,再行腰椎侧方椎体间融合术。记录脊柱内镜操作时间及额外增加的透视次数,术前及术后3个月采用VAS评分、ODI评分对临床疗效进行评估。[结果] 15例患者均顺利完成手术,术中无神经根、硬膜损伤,术后MRI证实原突入椎管的髓核组织被清除;术后腰腿痛VAS评分和ODI评分与术前比较差异均具有统计学意义(P<0.01)。[结论]经OLIF通道辅助脊柱内镜直接减压适用于伴明显腰椎间盘突出症的腰椎退变性疾病,可一期前路同时完成直接减压及间接减压,扩展OLIF手术适应证,符合脊柱微创理念。

[Objective]To explore the clinical efficacy and technical keynotes of endoscopic assisted oblique lumbar interbody fusion(OLIF) for lumbar degenerative diseases.[Methods]From May 2016 to August 2017,15 patients,including 7 males and 8 females aged 37~72 years with a mean of(54.92±10.14) years,underwent surgical treatment in our hospital for lumbar degenerative disease accompanied with lumbar disc herniation.After tubular retractor was docked on to create a proper passageway for OLIF,the endoscope combined with working channel was introduced through the corridor to the herniated disc,and then the herniated disc was removed under endoscope.Subsequently,lumbar interbody fusion was performed by standard OLIF procedure.The time elapsed in endoscope procedure and the additional times of fluoroscopy were recorded,additionally,the VAS scores for back and leg pain,as well as ODI score were used for assessment of the clinical outcome.[Results]All patients had operation performed successfully without nerve root or dural sac injuries.Postoperative MRI revealed that the herniated discs were removed.Compare with those before operation,the VAS scores for both back pain and leg pain,as well as the ODI scores significantly decreased postoperatively(P<0.05).[Conclusion]Endoscopic assisted OLIF takes benefits of direct or indirect decompression at the same stage,avoiding posterior procedures,is a safe,minimal invasive and effective treatment for lumbar degenerative diseases accompanied with intervertebral disc herniation.