经椎板间隙内窥镜下分开黄韧带切除椎间盘

背景：经椎板间隙途径内窥镜下间盘切除需游离黄韧带，后者如果辅助连续扩张器及工作通道进行操作，无论切口多小(甚至3-5 mm)，均可完整保留黄韧带。 目的：介绍经椎板间隙内窥镜下分开黄韧带切除椎间盘的应用。 方法：采用经椎板间隙内窥镜下分开黄韧带椎间盘切除治疗16 例男性患者和14例女性患者，平均年龄(48±15)岁，主诉单下肢根性疼痛，病变位于L_3-4间隙1例，L_4-5间隙13例，L₅-S₁间隙16例，其中间盘向上脱出游离者4例，向下脱出游离者7例，所有患者术中电生理监测，在工作通道中分开黄韧带，间盘切除撤出工作通道后，黄韧带可自行复位。 结果与结论：操作时间20-40 min，治疗后随访时间(149±108) d。治疗中电生理监测无异常，椎间盘切除症状均得以改善。经核磁随访显示：脱出间盘组织已完全摘除，黄韧带保留完整，所有患者无相关并发症。结果可见经椎板间隙内窥镜下分开黄韧带切除脱出的间盘组织，是一种可行的操作方式。

Endoscopic interlaminar lumbar discectomy with splitting of ligamentum flavum

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how small the incision may be (even 3-5 mm). OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting. METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L_3-4 in one case, L_4-5 in 13 cases and L₅-S₁ in 16 cases. The ruptured disc migrated superiorly in four cases and inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in all surgeries. The ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself.  RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the follow-up period was (149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in all patients after the operation. Follow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in all the patients. Interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting is a feasible approach.