经皮椎弓峡部椎间孔成形全内镜下腰椎间盘摘除术治疗头侧超高度移位型腰椎间盘突出症

Percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy for very highly up-migrated lumbar disc herniation

目的报告经皮椎弓峡部成形、全内镜下腰椎间盘摘除术(percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy,PIF-FELD)治疗头侧超高度移位型腰椎间盘突出(very highly up-migrated lumbar disc herniation,VHUM-LDH)的技术细节及临床疗效。方法2014年1月至2017年12月,共16例VHUM-LDH患者接受PIF-FELD手术治疗。术后2天及术后3个月复查腰椎MRI评估脱出物摘除及神经减压的彻底性。随访患者术后2天、术后3个月、6个月、1年及2年时的腰痛及腿痛的视觉模拟评分(visual analogue scale,VAS),腰椎Oswestry功能障碍指数(oswestry disability index,ODI)。术后2年随访时评估MacNab评分及神经根功能恢复情况。结果所有手术均顺利完成,无术中更改手术方式发生。术中发现脱出物为一整块游离者5例,其余11例均为多块游离型。术中无硬膜撕裂、神经损伤并发症,术后无感染、脑脊液漏、神经根功能损伤加重、椎间盘突出复发等并发症发生。所有患者术后复查腰椎MRI均显示脱出物摘除完全、神经减压充分。术后患者腰痛VAS、腿痛VAS及ODI评分较术前均明显改善(P<0.01);2年随访时,受累神经根支配区感觉及肌力较术前明显恢复(P<0.05);但腱反射功能无明显恢复(P>0.05)。术后2年随访时,MacNab评分包括优6例,良9例,可1例。结论PIF-FELD是治疗VHUM-LDH的安全、有效的微创脊柱外科手术技术。

Objective To report the technical notes and clinical outcomes of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy(PIF-FELD)for the treatment of very highly up-migrated lumbar disc herniation(VHUM-LDH).Methods A total of 16 patients with VHUM-LDH underwent PIF-FELD from January 2014 to December 2017.MRI of the lumbar spine was reexamined on the second day and 3 months after operation to evaluate the disc fragmentectomy and nerve decompression.Visual analogue scale(VAS)of the lumbar pain and leg pain,and Oswestry disability index(ODI)2 days,3 months,6 months,1 year and 2 years after operation were followed up.MacNab score and nerve root function recovery were evaluated 2 years postoperatively.Results All operations went smoothly without any changes in the surgical method.Single sequestered fragments were found in 5 patients intraoperatively,while multiple-sequestered fragments in 11 patients.No dural tear,nerve injury,infection,cerebrospinal fluid leakage,exacerbation of nerve root functions,or recurrence of disc herniation was observed.Postoperative reexamination of the lumbar MRI in all patients showed complete disc fragmentectomy and adequate nerve decompression.VAS of the low back and leg pain,and ODI scores were significantly improved compared with those preoperatively(P<0.01).The sensation and muscular strength of the affected nerve root innervation area were significantly restored than that preoperatively at 2 years’follow-up(P<0.05),while the tendon reflex function not(P>0.05).MacNab scores 2 years postoperatively:excellent 6;good 9;fair 1.Conclusions PIF-FELD is a safe and effective minimally invasive spine surgery technique for VHUM-LDH.