内镜可视化“V”区解剖引导下椎间孔成形术

Endoscopic foraminoplasty under visual “V” zone anatomic guidance for lumbar lateral recess stenosis

[目的]介绍可视化"V"区解剖引导下椎间孔成形技术及初步临床结果。[方法] 2017年12月~2018年12月对37例腰椎侧隐窝狭窄症患者采用内镜可视化"V"区解剖引导下椎间孔成形术。术前确定病变的位置与程度,穿刺至目标关节突任意位置,置入软组织扩张导杆,滑移到患侧上关节突与椎弓根交界处,即"V"区,此处向背侧有上关节突硬性阻挡,向尾侧有椎弓根硬性阻挡,向腹侧有椎体后缘硬性阻挡。用7.5 mm环锯对该部位进行成形,置入内镜,对椎间孔区进行扩大减压。[结果] 37例患者均顺利完成手术,术中均未更换手术方式。术中未出现神经、硬膜损伤等并发症。随访时间9~30个月。随时间推移,37例患者下肢痛VAS、腰痛VAS和ODI评分显著减少(P<0.001)。术后影像显示所有患者目标减压区域均实现彻底减压,无节段失稳表现。[结论]内镜可视化"V"区解剖引导下椎间孔成形技术治疗腰椎侧方椎管狭窄症有效、安全,可以提高穿刺及椎间孔成形效率,有助于缩短学习曲线。

[Objective]To introduce surgical technique of endoscopic foraminoplasty under visual"V"zone anatomic guidance for treatment of lumbar lateral recess stenosis.[Methods]From December 2017 to December 2018,37 patients underwent endoscopic foraminoplasty under visual"V"zone anatomic guidance for lumbar lateral recess stenosis.Based on the location and extent of lesion confirmed by images preoperatively,the puncture needle was inserted into anywhere around the target superior articular process.After exchange to a dilator,the dilator was glided to the junction of superior articular process and pedicle root,the V-shaped zone,where the dilator was held up caudally by the pedicle root,posteriorly by the superior facet,anteriorly by vertebral body.As the position verified by fluoroscopy,facetoplasty was conducted with a trephine 7.5 mm in diameter.After that,decompression of foraminal area was conducted under vision of endoscope.[Results]All the patients had operation completed successfully,without change of operation method and with no serious complications,such as nerve and dural injuries.As time went during follow-up period lasted for 9~30 months,the VAS scores for leg pain and low back pain,as well as ODI score significantly decreased(P<0.05).The postoperative images revealed that complete decompression on the target area was achieved in all the 37 patients without the signs of segmental instability.[Conclusion]The endoscopic foraminoplasty under visual"V"zone anatomic guidance is effective and safe technique for lumbar lateral recess stenosis,with benefits of improving puncture efficiency and flattening the learning curve.