脊柱内镜辅助套管内微创经椎间孔椎体间融合术的初步应用

Preliminary Application of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Spinal Canal Assisted Spinal Endoscopy System

目的探讨脊柱内镜辅助套管内微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎间盘突出症的安全性和有效性。方法回顾性分析2017年1月~2018年1月行脊柱内镜辅助套管内MIS-TLIF技术治疗12例单节段腰椎间盘突出症的资料。在椎间孔镜系统下完成突出椎间盘切除,确认神经根走行,在套管下行椎间融合,经皮行椎弓根螺钉固定。结果12例手术顺利,手术时间(124.8±33.5)min,术中出血量(156.4±46.1)ml。术后随访(15.6±3.9)月。术后1周及末次随访时的视觉模拟评分(Visual Analog Scale,VAS)及Oswestry功能障碍指数(Oswestry disorder index,ODI)与术前相比有显著改善(P=0.000),均获骨性融合。末次随访时改良MacNab疗效评定结果:优6例,良5例,可1例,优良率为92%。结论微创脊柱内镜辅助套管内MIS-TLIF技术治疗单节段腰椎间盘突出症安全、有效。

Objective To investigate the feasibility,safety and efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with spinal canal assisted spinal endoscopy system in the treatment of lumbar disc herniation.Methods A retrospective analysis of 12 patients with single-segment lumbar disc herniation from January 2017 to January 2018 was performed.All the patients underwent MIS-TLIF assisted spinal endoscopy system surgery.The discectomy was performed under the intervertebral foramen system,with the nerve roots carefully confirmed intraoperatively.The intervertebral fusion was performed in the cannula,and the pedicle screws were fixed by percutaneous approach.Results All the patients underwent operation successfully.The operation time was (124.8±33.5) min,and the intraoperative blood loss was (156.4±46.1) ml.The patients were followed up for (15.6±3.9) months.The Visual Analog Scale (VAS) scores and Oswestry disorder index (ODI) at 1 week and at the last follow-up were significantly improved as compared with preoperation (P=0.000),and all patients received bone fusion.The results of modified MacNab criteria at the last follow-up were excellent in 6 cases,good in 5 cases,and fair in 1 case,the excellent and good rate being 92%.Conclusion MIS-TLIF with minimally invasive spinal canal assisted spinal endoscopy system is a safe and effective surgical procedure for the treatment of single-segment lumbar disc herniation.