单侧双通道镜下置入超大型号笼架椎间融合

Large cage placement by unilateral biportal endoscopic technique for lumbar interbody fusion

[目的]介绍单侧双通道内镜下置入超大型号笼架椎间融合的手术技术与初步经验。[方法]术前测量行走神经根与出口神经根之间的距离,选择>16 mm的一侧为入路侧。术中透视定位,建立同侧的内镜与工作两个通道。镜下切除部分椎板和关节突,切除椎间盘,至终板下骨。再次测量神经根间距离,选择合适的超大型号笼架。牵开保护神经根,镜下配合透视,椎间植骨,置入笼架,经皮双侧椎弓钉固定。[结果]患者,男性,49岁,腰椎MRI示L_(4/5)椎间盘巨大突出伴椎管狭窄。手术顺利完成,时间为135 min,术后安返病房。置人笼架型号为12mm×6mm×40mm;术后引流量20ml;术中、术后未出现严重神经、血管损伤等并发症。术后患者症状缓解,下肢VAS评分从术前7分改善至2分,J0A评分从术前12分改善为22分。术后复查X线片及MRI示内固定在位,椎管、神经根减压满意。[结论]单侧双通道内镜下置人超大型号笼架技术可行,并取得良好的初步结果,但对手术经验及学习曲线具有一定的要求。

[Objective]To introduce the surgical technique and preliminary experience of large cage placement by unilateral biportal endoscopy(UBE)for lumbar interbody fusion.[Methods]After measuring the distance between the passing nerve root and the exiting nerve root on images before the operation,the side>16 mm was selected as the approach side.Based on intraoperative fluoroscopic positioning,two portals were established for endoscopy and working instruments respectively on the same side.Under the endoscope,part of the lamina and facet processes were removed,and the intervertebral discs were removed to expose bone under the endplate.As the distance between nerve roots was checked again under endoscopic vision,a suitable large cage was selected.After retracting and protecting the nerve roots,bone autografts were filled into the intervertebral space,and then the large cage was inserted into the space under monitoring of endoscopy and fluoroscopy.Finally,bilateral percutaneous pedicle screws was conducted for fixation.[Results]The patient,a 49-year-old male,was diagnosed of L_(4/5) huge disc protrusion accompanied with spinal stenosis on MRI,and underwent the operation successfully with 12×16 × 40mm cage inserted in total operation time of 135 minutes,whereas without serious neurological and vascular complications during and after the operation.The symptoms were relieved satisfactorily postoperatively with improvement of the VAS score of lower limb pain from 7 preoperatively to 2 postoperatively,whereas the JO A score improvement from 12 before surgery to 22 postoperatively.Postoperative X-rays and MRI showed that the internal fixation was in proper place,and the spinal canal and nerve root were decompressed satisfactorily.[Conclusion]The technique of large cage placement by unilateral biportal endoscopy is feasible,and achieves good preliminary results,but there are certain requirements for surgical experience and learning curve.