极外侧型腰椎间盘突出症15例报告

目的 探讨极外侧型腰椎间盘突出症的临床和CT特征,提高该病的诊断率。方法 对15例经手术证实的患者临床和CT影像进行回顾性分析。结果 腰4／5间隙多发,椎间孔和椎间孔外联合突出多见,临床上常可见单侧两节神经根受损的表现。结论 临床与CT相结合是诊断极外侧型腰椎间盘突出症的关键。     

老年腰椎间盘突出症的特点与手术治疗

目的:探讨老年腰椎间盘突出症的特点与手术治疗效果。方法:对98例老年腰椎间盘突出症患者的临床与病理特点进行分析。男55例,女43例,平均年龄65.7岁。均行腰椎后路椎板减压髓核摘除术,其中小切口开窗56例,半椎板切除32例,全椎板切除10例,根据手术前后JOA评分评价手术疗效。结果:老年腰椎间盘突出症病理以髓核组织的脱水,纤维环的破裂,小关节囊、周围韧带及软骨终板退变为主要特点。临床特点为下肢疼痛多发,腰部活动受限较多;双下肢神经系统检查肌力下降明显,生理反射改变明显。98例平均随访2.2年,JOA评分术后平均改善率为70.9%,手术前后JOA评分比较差异有显著性意义(P<0.05)。结论:老年腰椎间盘突出症患者病程长,体征多,病理改变明显,行腰椎后路椎板减压髓核摘除术,手术效果满意。     

经椎间孔入路经皮内窥镜下腰椎椎间盘切除术治疗高位腰椎椎间盘突出症

目的探讨经椎间孔入路经皮内窥镜下腰椎椎间盘切除术(PETD)治疗高位腰椎椎间盘突出症的临床疗效。方法回顾性分析2010年8月—2014年5月本院采用PETD治疗的24例高位腰椎椎间盘突出症患者临床资料。记录手术时间、术中出血量、住院天数,术前及术后12个月腰腿疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),采用Macnab标准评价临床疗效。结果所有患者手术顺利完成。手术时间60~100 min,平均74.6 min;手术出血量15~40 m L,平均24.0 m L;住院天数3~7 d,平均4.3 d;随访时间14~36个月,平均21.1个月。术前腰痛VAS评分为(6.88±1.33)分,术后12个月为(1.96±0.91)分,差异有统计学意义(P0.01);术前腿痛VAS评分为(7.67±1.27)分,术后12个月为(1.83±0.76)分,差异有统计学意义(P0.01)。术前ODI值为(68.8±8.4)%,术后12个月为(20.4±5.6)%,差异有统计学意义(P0.01)。根据Macnab标准,术后12个月随访时优16例、良5例、可2例,差1例,优良率为87.5%。结论 PETD治疗高位腰椎椎间盘突出症能够取得较为满意的疗效,是治疗高位腰椎椎间盘突出症的有效方法。     

Wiltse人路联合传统入路治疗极外侧型腰椎间盘突出症

目的探讨Wiltse入路联合传统入路经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion,TLIF）治疗极外侧型腰椎间盘突出症的临床疗效。方法对行手术治疗的34例极外侧型腰椎间盘突出症患者,随机分组采用Wiltse入路联合传统入路17例,单纯传统后正中入路17例,均应用TLIF技术治疗。所有患者术后均随访1年,记录手术时间、术中出血量,术后引流量。比较术前术后的疼痛视觉模拟（visual analogue scale,VAS）评分、日本骨科协会（Japanese orthopaedic association,JOA）腰痛评分、Oswestry功能障碍指数、MRI所示的健侧多裂肌残存率。结果 34例患者经1年的随访,各项比较指标除术后1年下肢痛VAS评分之外,差异均有统计学意义（P〈0.05）。结论 Wiltse入路联合传统入路经椎间孔椎体间融合术治疗极外侧型腰椎间盘突出症可达到与单纯传统后正中入路治疗极外侧型腰椎间盘突出症相同的手术效果,但它对椎旁肌的损伤更小,更利于患者的术后恢复。     

Facet tropism: a comparison between far lateral and posterolateral lumbar disc herniations

STUDY DESIGN: An assessment of the difference in the degree of facet tropism and disc degeneration between far lateral and posterolateral lumbar disc herniations. OBJECTIVE: To investigate the effect of the difference in the degree of the facet tropism and disc degeneration with respect to the development of far lateral lumbar disc herniation and posterolateral lumbar disc herniation, and to compare the effect between the two types of herniations. SUMMARY OF BACKGROUND DATA: The effect of facet tropism on the development of posterolateral lumbar disc herniation has been investigated previously, but there has been no study on far lateral lumbar disc herniation. METHODS: Thirty-eight lumbar disc herniations (far lateral, n = 19; posterolateral, n = 19) were included this study. The degree of facet tropism and disc degeneration was measured at the herniated disc level by using magnetic resonance imaging. The results were compared to show any differences between the two types of lumbar disc herniations. RESULTS: There were significant differences in the degree of facet tropism (24.74 vs. 14.26, P = 0.004) and disc degeneration (23.92 vs. 15.08, P = 0.005) between the far lateral and posterolateral lumbar disc herniations. There was no significant correlation between the degree of facet tropism and the degree of disc degeneration in far lateral lumbar disc herniation (r = -0.369, P = 0.120). CONCLUSION: This results suggest that the differences in the degree of facet tropism and disc degeneration might be considered a key factor in distinguishing the development of far lateral lumbar disc herniation from that of posterolateral lumbar disc herniation.     

A minimally invasive technique for L5-S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach

Surgical treatment of intraforaminal disc herniations at the L5-S1 level is technically demanding. The 2 most commonly used procedures involve either a medial or lateral ipsilateral approach and often require a partial or even complete facet resection, which may in turn result in vertebral instability and/or back pain, as well as, in some cases, a fusion or stabilization procedure. In this report, the authors present a new minimally invasive technique for the treatment of L5-S1 intraforaminal disc herniations. Using this technique, which involves tubular retractors and an operative microscope to approach the neural foramen from the contralateral side, the authors could easily visualize and remove the herniated disc material and perform a thorough microdiscectomy with minimal resection of osseous and ligamentous structures. To illustrate this new minimally invasive technique for the treatment of intraforaminal disc herniations at L5-S1, they describe the cases of 2 patients who underwent the procedure and in whom successful results were achieved.     

Topography of the uncinate fascicle and adjacent temporal fiber tracts

Summary A prospective intra-operative analysis of the location of lumbar disc herniation was performed in 131 patients with verified 54% contained (incomplete) and 46% non-contained (complete) lumbar disc herniations. Bulging discs or protrusions are not included in this study.Complete disc herniations occurred more frequently in the upper lumbar spine. The localization of the lumbar disc herniations within its segment showed no correlation to the affected level. 64% of the disc herniations were located medio-laterally, 20% laterally, 12% within or lateral of the intervertebral compartment and 5% in the midline. Nearly one third of all herniations were found at the level of the disc space. Medio-lateral disc herniations were displaced more often in a caudal direction, lateral herniations were found displaced upwards and downwards with similar frequency while extraforaminal herniations migrated significantly more often in a cranial direction.The pathomechanism and anatomical pathways of disc fragment migration are discussed on the basis of a new concept of the anterior extradural space.Dedicated to Prof. Peter Huber, our respected neuroradiologist and friend.     

杨氏椎间孔镜治疗腰椎间盘突出症的远期疗效

[目的]应用回顾性研究方法,探讨采用杨氏椎间孔镜( YESSTM)技术治疗腰椎间盘突出症的远期疗效.[方法] 2000年6月～2003年5月期间采用YESSTM系统治疗112例腰椎间盘突出症患者,81例(72.3％)获得至少60个月随访(60～127个月,平均71.7个月).男48例,女33例;年龄17～56岁,平均32.7岁.其中,椎孔型和椎间孔外型64例,后外侧突出型25例,中央型2例.33例合并神经根管狭窄的行椎间孔成形术.术前、术后2周和末次随访时分别对患者进行下肢疼痛的VAS评分;Nakai分级法评估治疗效果.[结果]所有患者手术均顺利完成,术中出血量30～120 ml,平均65 ml,手术时间35～140 min,平均70 min.无严重并发症,无椎间隙感染.5例(4.46％)术后无效,4例(3.35％)术后随访3～72个月复发,均再次行翻修术.14例(12.5％)术后出现一过性下肢疼痛加重,保守治疗后缓解.术前、术后2周和末次随访下肢疼痛的VAS评分分别为(7.4±2.1)、(2.4±0.81、(2.2±0.6).术后和末次随访评分较术前差异显著.Nakai分级法术后和末次随访的优良率分别为82.7％和77.7％,远期优良率无统计学差异.[结论]椎间孔镜YESSTM技术治疗腰椎间盘突出症能够获得良好的远期疗效.     

Intradural lumbar disc herniation—Is it predictable preoperatively? A report of two cases

BACKGROUND CONTEXT: Intradural disc herniations are thought to be rare events, and there have been relatively few literature reports of intradural disc herniations available with regard to magnetic resonance imaging findings. PURPOSE: The authors describe two patients with intradural lumbar disc herniations, one with and one without preoperative diagnosis, who had different postoperative outcomes. STUDY DESIGN: Case study METHODS: The first patient underwent an extended L3 subtotal laminectomy followed by bilateral medial facetectomy and foraminotomy at L3-L4. A durotomy uncovered large disc fragments comprised of friable disc materials and end plates, after no clear disc herniation was found in the epidural space. The second patient underwent anterior lumbar interbody fusion after a preoperative diagnosis of intradural disc herniation. RESULTS: The first patient experienced a marked reduction of pain and progressive recovery of sensory disturbance, but neurologic examination showed right foot drop postoperatively. Two years after surgery, she can not walk without a cane because the neurologic deficit of the right ankle has shown no improvement. Two days after surgery, the second patient was allowed to ambulate with a lumbar orthosis. Neurologic examination showed no motor deficit. Twenty-one months after surgery, the patient reports minimal back pain when sitting on a chair for prolonged periods of time. CONCLUSION: Our cases highlight the importance of preoperative diagnosis in the treatment of intradural lumbar disc herniations. The potential presence of an intradural disc herniation must always be considered preoperatively on a patient whose magnetic resonance imaging study demonstrates the "hawk-beak sign" on axial imaging as well as abrupt loss of continuity of the posterior longitudinal ligament (PLL). This association results in an adequate surgical approach, thereby reducing the chance of postoperative neurologic deficit. Finally, anterior lumbar interbody fusion can be a reasonable alternative in the treatment of intradural lumbar disc herniations.     

Computed tomographic investigation of the effect of traction on lumbar disc herniations

The aim of this study was to evaluate the effect of static horizontal traction on disc herniations by computed tomographic investigation. Changes occurring under the effect of a traction load of 45 kg have been evaluated in 30 patients with lumbar disc herniation. The herniated nuclear material (HNM) has retracted in 11 (78.5%) of median, six (66.6%) of posterolateral, and four (57.1%) of lateral herniations. Clinical response of these cases to conservative treatment varied with the amount and location of HNM, the retraction of HNM, and calcification of protruded disc. Static lumbar traction showed variable effects on lumbar disc herniations, especially in relation with the amount and location of HNM.     

The microsurgical approach to extraforaminal lumbar disc herniations. An analysis of 15 cases

AIM: Extraforaminal lumbar disc herniations are uncommon, but thanks to recent progress in imaging procedures, they may be easily diagnosed. Several surgical approaches have been described and employed to remove these herniations. The aim of this study is to evaluate the clinical, radiological and surgical features which differentiate the treatment of this type of hernia from the more common surgical approaches to other types of lumbar disc hernias. METHODS: The authors report the results of the surgical treatment of 15 cases of extraforaminal lumbar disc herniation through an extracanalicular, intertransverse microsurgical approach and describe the technique employed. RESULTS: All cases experienced a prompt recovery from the preoperative symptoms with no complications, which notably reduced the time necessary for postoperative care. No instability was documented and none of the cases observed presented the neuropathic pain sometimes reported with this method of approach to these herniations. CONCLUSION: This particular site of disc herniation can be approached effectively through the extracanalicular route. The procedure, however, requires an extremely accurate preoperative anatomical evaluation and a good microsurgical experience.     

Speculum lumbar extraforaminal microdiscectomy

BACKGROUND CONTEXT: Public interest, monetary pressures and improving diagnostic techniques have placed an increasing emphasis on minimalism in lumbar disc excision. Current techniques include microlumbar discectomy and minimally invasive spinal surgery. Both are good techniques but may be painful, require a hospital stay and/or are not widely used because of difficulty acquiring the necessary skills. The author therefore developed a less invasive microscopic technique that may be performed on a consistent outpatient basis with easily acquired skills. PURPOSE: The purpose of this study was to describe a variant of minimally invasive lumbar disc excision, while assessing the effects on a small group of patients. STUDY DESIGN: The treatment protocol was a prospective community hospital-based case study designed to evaluate a less invasive method of excising herniated lumbar discs residing in the canal, foraminal or far lateral space. PATIENT SAMPLE: This study is comprised of 50 patients with all anatomic forms of lumbar disc herniations, inside or outside the canal, at all levels except the lumbosacral joint. OUTCOME MEASURES: Clinical results were measured by return to work time, the criteria of MacNab and by Prolo et al.'s economic and functional criteria. METHODS: Selection criteria included adult patients with intractable low back and leg pain, plus an imaging study revealing a lumbar disc herniation consistent with the patient's clinical presentation. Mean patient age was 48 years. The male:female ratio was approximately 2:1. All patients failed at least 3 weeks of conservative therapy. Herniations occurred from the L2-3 space through L4-5, with 30 herniations being within and 20 outside the spinal canal. Both contained and extruded/sequestered herniations were treated. Excluded from the study were patients with herniations inside the spinal canal at the L5-S1 level. Surgical approach was by microscopic speculum transforaminal route for discs residing both within and outside the lumbar canal. RESULTS: The initial 50 consecutive patients had successful technical operations performed on an outpatient basis by this less invasive technique. By the criteria of MacNab (Table 3), 84% (42 of 50) had an excellent or good result, returning to work at a mean time of 3.5 weeks. Per Prolo et al.'s economic scale, 72% were disabled at levels I and II before surgery. Postoperatively, 92% had improved to levels IV and V. Similarly, on his functional scale, 94% functioned at levels I and II before surgery, whereas 88% achieved levels IV and V after surgery. Eighty percent required no pain medications 1 week after surgery. The only complication was an L3 minor nerve root injury as it exited the L3-4 foramen. CONCLUSION: The author has described a minimally invasive technique for excising herniated discs that is applicable to all types of lumbar herniations, except for those residing in the canal at L5-S1. Clinical outcomes are comparable to those of other forms of discectomy.     

Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.     

Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients.

BACKGROUND: Extraforaminal disc herniations represent up to 11% of all lumbar herniated discs. Numerous surgical approaches have been described. Percutaneous endoscopic discectomy (PED) is one of the minimally invasive techniques; after mastering this procedure it is a practical method that is used for treatment of foraminal or extraforaminal disc herniation. The outcome of PED for treatment of foraminal or extraforaminal disc herniation has been studied. METHOD: A total of 66 patients with foraminal or extraforaminal lumbar disc herniation was treated by applying the PED technique between January 1998 and June 2005. The positions of the herniated disc levels were L2-3 (n=5, 8%), L3-4 (n=19, 28%) and L4-5 (n=42; 64%). The selected patients had no previous surgery, appropriate conservative therapies were done before the operations, and MRI was the main diagnostic method with the clinical findings. Evaluation of the patients with clinical examinations, visual analogue pain scale (VAS) and Oswestry scale was performed preoperatively, on postoperative day 7 and in the postoperative 6-12 months period. RESULTS: In two patients (n=1, L4-5 and n=1, L3-4) disc material could not be removed with PED, so discectomy was performed with microscopic visualization during the same session. Three patients (n=3, L4-5) were reoperated on three to six months after primary surgery due to recurring disc problems with microscope visualization. In two patients (n=2, L4-5) root nerves were partially damaged, and in two patients (n=2, L4-5) root nerves were impinged by the working channel. These 4 patients had dysesthesias from just after surgery to a mean of 45 days after surgery. One of recurrent cases was among these patients. Neurological examinations showed minimal muscle weakness of the quadriceps femoris and diminished sensation of the L4 dermatomal area in patients with partial nerve root damage. This patient improved and the neurologic examination became normal with disappearance of the dysesthesia. There was no sign of reflex sympathetic dystrophy (RDS). With these two patients VAS and Oswestry scales scores decreased significantly early in the postoperative follow-up. The postoperative 6-month average scores are favourable in comparison with the average score at postoperative day 7. The postoperative 12-month scores showed no significant differences to those of postoperative month 1. CONCLUSION: Percutaneous endoscopic discectomy is a minimally invasive method and offers many benefits to the patient, but extensive surgical practice is needed to become a capable surgeon. Consequently this technique can only be a treatment option on appropriate patients. This study reconfirmed that the removal of fragmented disc material is achieved and offers a pain-free status.     

显微减压术治疗椎间孔内腰椎间盘突出

目的 :总结显微减压术治疗椎间孔内腰椎间盘突出的临床应用结果。方法 :2005年9月至2013年5月,对16例椎间孔内腰椎间盘突出患者采用显微减压术治疗,其中男12例,女4例;年龄32~56岁,平均38.6岁;L3,41例,L4,510例,L_5S_15例。结果:16例均获随访,时间20~48个月,平均36个月。术后恢复率按Macnab腰腿痛手术治疗评定标准进行疗效评定,优12例,良好4例,未发生与该项技术操作相关的并发症。结论:显微减压术适宜治疗椎间孔内腰椎间盘突出,老年人更容易耐受。     

A minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study

BACKGROUND: Among all lumbar disc herniations, L5-S1 far-lateral disc herniations are rare entities. Besides, surgical approach may be difficult because of the very narrow passage at this level. For these 2 reasons, most spine surgeons are not experienced in herniations at this level. According to new microanatomic studies, previous lateral approaches at this level often do not allow access to the neuroforamen without partial or total destruction of the L5-S1 facet joint. To preserve the facet joint, an approach was developed. PURPOSE: To assess the efficacy of a surgical technique that is a minimally invasive intermuscular approach (MIIMA) for decompression of L5-S1 far-lateral level disc herniation (FLLDH). STUDY DESIGN: We present a prospective clinical study analysis of 14 patients with L5-S1 far-lateral disc herniations in a period between 2000 and 2004, treated with microsurgical technique. METHODS: An imaging study revealed consistency with the patient's clinical presentation. In our department, a total of 580 patients underwent discectomy between 2000 and 2004 for lumbar disc herniation. RESULT: Twenty-eight patients had foraminal or extraforaminal herniations (4.8%). Fourteen patients had FLLDH at the L4-L5 level (2.4%), whereas the other 14 were cases of FLLDH at the L5-S1 level (2.4%). One patient had FLLDH at both L5-S1 and L4-L5 levels (7.1%). The mean age of patients was 53.6 years, and the male:female ratio was approximately 5:9. All patients failed to recover after at least 6 weeks of conservative therapy. The mean duration of symptoms until the time of surgery was 7.2 months. Using this MIIMA technique, the authors removed the herniated discs compressing the (L5) nerve roots. Clinical outcome was measured using the visual analog scale. Every patient was discharged within 24 hours. Satisfactory (excellent or good) results were demonstrated in 13 patients (92.9%), because, except for 1 (7.1) permanent dysesthesia case, 4 cases (21.3%) were temporary dysesthesia. Postoperatively all patients reported excellent relief of their sciatic pains, and there were no technique-associated complications. No recurrence was observed during the follow-up period ranging from 10 to 60 months (mean, 29 mo). This is one of the major complications of any approach to a far-lateral disc. CONCLUSIONS: The authors describe a MIIMA for excising herniated discs that is applicable to all types of far-lateral lumbar herniations. Postoperative dysesthesia is the most important complication and may persist as it did in our cases. Consequently, manipulation of the ganglion should be avoided at all costs, if possible. The MIIMA procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone herniated discs in selected cases. This approach is effective, allowing the preservation of the L5-S1 facet joint, saving the facet joint, preventing postoperative instability, and offering a direct view of the L5-S1 neuroforamen.     

Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation

OBJECTIVE: To demonstrate the feasibility of anterior lumbar microdiscectomy in patients with recurrent, sequestered lumbar disc herniations. METHODS: Between 1997 and 1999, six patients underwent a muscle-sparing "minilaparotomy" approach and subsequent microscopic anterior lumbar microdiscectomy and fragmentectomy for recurrent lumbar disc extrusions at L5-S1 (n = 4) or L4-L5 (n = 2). A contralateral distraction plug permitted ipsilateral discectomy under microscopic magnification. Effective resection of the extruded disc fragments was accomplished by opening the posterior longitudinal ligament. Interbody fusion was performed by placing cylindrical threaded titanium cages (n = 4) or threaded allograft bone dowels (n = 2). RESULTS: There were no complications, and blood loss was minimal. Follow-up magnetic resonance imaging revealed complete resection of all herniated disc material. Plain x-rays revealed excellent interbody cage position. Radicular pain and neurological deficits resolved in all six patients (mean follow-up, 14 mo). CONCLUSION: Anterior lumbar microdiscectomy with interbody fusion provides a viable alternative for the treatment of recurrent lumbar disc herniations. Recurrent herniated disc fragments can be removed completely under direct microscopic visualization, and interbody fusion can be performed in the same setting.     

A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients.

Anterior cervical decompression and fusion (ACDF) is the standard procedure for operation of cervical disc herniations with radicular arm pain. Mobility-preserving posterior foraminotomy is the most common alternative in the case of a lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, since they may offer advantages in surgical technique and rehabilitation. These days, all disc herniations of the lumbar spine can be operated in a full-endoscopic technique. The objective of this prospective study was to examine the technical possibilities of full-endoscopic posterior foraminotomy in the treatment of cervical lateral disc herniations. 87 patients were followed for 2 years. The results show that 87.4% no longer have arm pain and 9.2% have only occasional pain. The decompression results were equal to those of conventional procedures. The operation-related traumatization was reduced. The recurrence rate was 3.4%. No serious surgical complications occurred. The recorded results show that the full-endoscopic posterior foraminotomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.     

腰椎间盘突出症后路微创手术的应用解剖与临床研究

[目的]为微创外科技术治疗腰椎间盘突出症提供解剖学基础,并提高其手术效果.[方法]30具成人尸体标本,测量椎板下缘骨嵴到同位椎体下缘、黄韧带附着点、棘突下缘、棘间韧带外缘的距离.临床应用椎间盘镜（MED）治疗腰椎间盘突出症368例.[结果]椎板下缘骨嵴位于棘突的头侧,L3、4椎板遮挡相应的椎间盘,L5椎板没有遮挡L5～S1椎间盘.临床随访368例,根据Nakai分级：优287例;良57例：可21例：差3例;优良率93.5%.[结论]在腰椎间盘突出症后路微创手术中,切口应以棘突下缘头侧椎板下缘骨嵴为中心.要显露L3～4或L4～5椎间盘,需切除L3或L4椎板下缘少部分;显露L5～S1椎间盘,不需咬除L5椎板下缘,同时只需切除少部分黄韧带,即可显露椎间盘与神经根,完成髓核摘除手术.对单节段旁中央型、外侧型腰椎间盘突出症MED才能达到微创手术,要提高MED手术效果,关键是严格掌握手术适应证,并具有丰富的开放式手术经验以及熟练的镜下操作技术.     

应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症

目的总结应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症的临床疗效。方法1999年2月至2002年12月,采用METRx椎间盘镜行髓核摘除术,治疗极外侧型腰椎间盘突出症14例,均为单间隙突出,其中男性10例、女性4例,年龄41-55岁,平均49岁。突出间隙：L4,5 6例、L5-S1 8例。突出类型：椎间孔突出型6例,椎间孔外侧突出型8例。结果14例随访12—46个月,平均26．5个月。疗效：优10例、良3例、可1例。术后4例遗留感觉障碍,无神经根损伤、椎问盘炎、硬膜囊撕裂、椎间盘突出复发等并发症。结论应用METRx椎间盘镜治疗极外侧型腰椎间盘突出症,手术创伤小、神经根减压彻底和术后恢复快,适用于极外侧型腰椎间盘突出症的治疗,选择正确的手术入路和术中仔细的操作是手术成功的关键．