三种不同微创方法治疗极外侧椎间盘椎间盘突出症的疗效观察

Study Design: Prospective consecutive series study.Objective: To discuss minimally invasive strategies, options and surgical indications for far lateral lumbar disc herniation(FLLDH) between three different minimally invasive procedures.Summary of Background Data：FLLDH represents up to 2.6% to 11.7% of all lumbar herniated discs. Numerous surgical approaches have been described. The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of lumbar f FLLDH.Methods: From June 2000 to March 2006, 52 patients with f FLLDH were treated with minimally invasive procedures. All the patients were assessed by anteroposterior and lateral roentgenograms and computed tomography (CT), and some of them were given additional myeography, discography, and magnetic resonance imaging (MRI). YESS, METRx and X-tube procedures were performed in 25, 13 and 14 cases respectively. 52 patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by use of the visual Analog Score (VAS) and Nakai criteria.Results: The results indicated that all the three procedures could significantly improve the radiating leg symptoms (P<0.005). The postoperative overall excellent and good rate for YESS, METRx and X-tube procedures were 84.0%, 84.6% and 92.8% respectively, with no statistical difference between the three groups (P>0.05). The YESS procedure showed several advantages including shortest operation time, simplest anesthesia and least trauma compared with the other two procedures, especially for simple type І of FLLDH. METRx procedure was more suitable for simple type II, and the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for FLLDH combined with degenerative lumbar instability. Conclusion: Minimally invasive strategies and options should be determined by different types of FLLDH. Key words: microspinal surgery, far lateral lumbar disc herniation, endoscopy.

The Clinical Efficacy of Three Different Minimally Invasive Procedures for Far Lateral Lumbar Disc Herniation