BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spi...BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.展开更多
目的探讨神经根造影加封闭(neurography and nerve root sealing,NNRS)的精确诊断在脊柱内镜镜下融合(Endo-P/TLIF)治疗多节段腰椎管狭窄合并腰椎失稳症中的应用。方法收集从2022年1月1日至6月21日广西中医药大学第一附属医院住院的多...目的探讨神经根造影加封闭(neurography and nerve root sealing,NNRS)的精确诊断在脊柱内镜镜下融合(Endo-P/TLIF)治疗多节段腰椎管狭窄合并腰椎失稳症中的应用。方法收集从2022年1月1日至6月21日广西中医药大学第一附属医院住院的多节段腰椎管狭窄合并腰椎失稳的患者共60例,所有患者术前均行神经根封闭造影确认责任节段并对其行Endo-P/TLIF治疗,随访6个月。记录患者的年龄、性别、病程、手术时间、术中出血、住院时间、下床时间;术前、术后、术后3个月和术后6个月的VAS评分、ODI评分、JOA评分、腰椎前凸角、椎间高度、硬膜横断面积、骶骨倾斜角、骨盆投射角、骨盆倾斜角;MRI提示、神经根封闭造影确认的责任节段和最终减压时的单节段、双节段、3节段及以上的例数,并进行统计学分析。结果所有患者均顺利完成手术,随访6个月过程中1例患者未按时复诊,1例患者失联,最终58例患者随访资料完整纳入统计。术后6个月改善率优55例,良2例,好转1例,总有效率100%。通过NNRS的责任节段得出单侧单节段、双侧单节段的责任神经节段明显多于腰椎MRI显示节段数,得出单侧、双侧双节段和3节段及以上的责任神经节段明显少于腰椎MRI显示节段数差异有统计学意义(P<0.05);术后VAS评分、ODI评分、JOA评分,VAS评分、ODI评分、JOA评分、腰椎前凸角、椎间高度、硬膜横断面积、骶骨倾斜角、骨盆倾斜角与术前相比差异均有统计学意义(P<0.05);骨盆投射角与术前比较差异无统计学意义(P>0.05),但仍有明显的改善。结论选择性NNRS的精确诊断的方法,能够在术前确认责任神经节段,在精确诊断的基础上运用Endo-P/TLIF手术方式治疗多节段腰椎管狭窄合并腰椎失稳症,责任节段精细减压,明显减小创伤和出血,缩短了住院时间,良好地恢复脊柱生理曲度,提高临床疗效,值得临床中广泛运用。展开更多
文摘BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.
文摘目的探讨神经根造影加封闭(neurography and nerve root sealing,NNRS)的精确诊断在脊柱内镜镜下融合(Endo-P/TLIF)治疗多节段腰椎管狭窄合并腰椎失稳症中的应用。方法收集从2022年1月1日至6月21日广西中医药大学第一附属医院住院的多节段腰椎管狭窄合并腰椎失稳的患者共60例,所有患者术前均行神经根封闭造影确认责任节段并对其行Endo-P/TLIF治疗,随访6个月。记录患者的年龄、性别、病程、手术时间、术中出血、住院时间、下床时间;术前、术后、术后3个月和术后6个月的VAS评分、ODI评分、JOA评分、腰椎前凸角、椎间高度、硬膜横断面积、骶骨倾斜角、骨盆投射角、骨盆倾斜角;MRI提示、神经根封闭造影确认的责任节段和最终减压时的单节段、双节段、3节段及以上的例数,并进行统计学分析。结果所有患者均顺利完成手术,随访6个月过程中1例患者未按时复诊,1例患者失联,最终58例患者随访资料完整纳入统计。术后6个月改善率优55例,良2例,好转1例,总有效率100%。通过NNRS的责任节段得出单侧单节段、双侧单节段的责任神经节段明显多于腰椎MRI显示节段数,得出单侧、双侧双节段和3节段及以上的责任神经节段明显少于腰椎MRI显示节段数差异有统计学意义(P<0.05);术后VAS评分、ODI评分、JOA评分,VAS评分、ODI评分、JOA评分、腰椎前凸角、椎间高度、硬膜横断面积、骶骨倾斜角、骨盆倾斜角与术前相比差异均有统计学意义(P<0.05);骨盆投射角与术前比较差异无统计学意义(P>0.05),但仍有明显的改善。结论选择性NNRS的精确诊断的方法,能够在术前确认责任神经节段,在精确诊断的基础上运用Endo-P/TLIF手术方式治疗多节段腰椎管狭窄合并腰椎失稳症,责任节段精细减压,明显减小创伤和出血,缩短了住院时间,良好地恢复脊柱生理曲度,提高临床疗效,值得临床中广泛运用。
