椎间孔前上象限成形入路治疗高度向上游离腰椎间盘突出症

Anterior Upper Quadrant Foraminoplasty Approach Percutaneous Endoscopy for Upwards Highly Migration Lumbar Disc Herniation

目的探讨椎间孔前上象限成形入路经皮内镜手术治疗高度向上游离腰椎间盘突出症的效果。方法回顾性分析2018年1月~2020年3月椎间孔前上象限成形入路经皮内镜手术治疗25例高度向上游离腰椎间盘突出症资料,其中L2/31例,L3/43例,L4/521例。比较术前、术后1个月及末次随访腰痛和下肢痛视觉模拟评分(Visual Analogue Scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI),末次随访以改良MacNab标准评价疗效。结果25例均顺利完成手术,手术时间45~98 min,平均62 min。25例随访6~30个月,中位时间14个月。术后腰痛VAS评分、下肢痛VAS评分、ODI均明显改善(P<0.05)。末次随访优18例,良5例,可2例,优良率92.0%(23/25)。结论对于L4/5及以上节段高度向上游离髓核位于上椎弓根下缘至上椎弓根中分之间的腰椎间盘突出症,椎间孔前上象限成形入路可以在内镜直视下完成游离髓核摘除,对椎管内结构干扰小,有限切除骨质不破坏脊柱的生物力学结构。

Objective To observe the clinical effect of treating upwards highly migration lumbar disc herniation by the anterior upper quadrant foraminoplasty approach under percutaneous spinal endoscopy.Methods A retrospective observational study was carried out on clinical information of 25 patients with upwards highly migration lumbar disc herniation from January 2018 to March 2020.The anterior upper quadrant foraminoplasty approach under percutaneous spinal endoscopy was carried out.Among them,1 case was L2/3,3 cases were L3/4,and 21 cases were L4/5.The Visual Analogue Scale(VAS)score of low back pain and lower limb pain and Oswestry Disability Index(ODI)before operation,1 month after operation and at the last follow-up were compared,and the modified MacNab criteria was used to evaluate the excellent and good rate.Results The operation time of the 25 patients was 45-98 min,with an average of 62 min.The follow-up time was 6-30 months,with a median of 14 months.Postoperative low back pain VAS score,lower limb pain VAS score,and ODI were significantly improved(P<0.05).At the last follow-up of the 25 cases,there were 18 cases of excellent,5 cases of good,and 2 cases of fair results according to the modified MacNab criteria,the excellent and good rate being 92.0%(23/25).Conclusions The anterior upper quadrant foraminoplasty approach under percutaneous spinal endoscopy is suitable for upwards highly migration lumbar disc herniation at the segment of L4/5 and above,namely the migration end of the nucleus pulposus located from the lower edge of the upper pedicle to the middle of the pedicle.This surgical method can complete the removal of free nucleus pulposus under the direct vision of percutaneous spinal endoscopy,and has advantages of less trauma,minimal interference to the structure of the spinal canal,and limited bone removal without destroying the biomechanical structure of the spine.