全脊柱内镜在骨化类继发性腰椎管狭窄症应用中的相关问题述评
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摘要
<正>腰椎管狭窄症(lumbar spinal stenosis,LSS)是指由先天性或后天性因素导致腰椎椎管、椎间孔狭窄,引起神经组织受压、血液循环阻碍,并出现臀部或下肢疼痛、神经源性跛行、伴或不伴腰痛症状的一系列综合征。LSS的分类较多,临床分类可分为中央椎管狭窄、侧隐窝狭窄及椎间孔狭窄,病因分类可以分为发育性LSS、继发性LSS两大类~([1]),发育性LSS是指先天性发育异常而导致的腰椎管狭窄,在后天的压迫因素下容
Percutaneous endoscopic surgery is currently widely used in the treatment of ossifying secondary lumbar spinal stenosis. But due to different kinds of ossification of lumbar spinal stenosis and surrounding implications, the choice and difficulty of percutaneous endoscopic surgery are different. Therefore the following aspects need to be evaluated comprehensively, including the surgery option, surgical plan design, ossification management. This article will discuss issues above combining with literature and clinical experience.
Percutaneous endoscopic surgery is currently widely used in the treatment of ossifying secondary lumbar spinal stenosis. But due to different kinds of ossification of lumbar spinal stenosis and surrounding implications, the choice and difficulty of percutaneous endoscopic surgery are different. Therefore the following aspects need to be evaluated comprehensively, including the surgery option, surgical plan design, ossification management. This article will discuss issues above combining with literature and clinical experience.
引文
[1]Lafian AM,Torralba KD.Lumbar spinal stenosis in older adults[J].Rheum Dis Clin North Am,2018,44(3):501-512.
[2]胡德新,郑琦,朱博,等.经皮椎间孔镜下选择性减压治疗老年性腰椎管狭窄症的疗效分析[J].中国骨伤,2014,27(3):194-198.
[3]何齐芳.老年性腰椎管狭窄的椎间孔镜治疗分析[J].中华全科医学,2015,13(6):902-905.
[4]徐宝山.经皮椎间孔镜和椎间盘镜治疗腰椎间盘突出症和椎管狭窄症的选择与应用[J].天津医药,2015,43(11):1239-1243.
[5]Grob D,Humke T,Dvorak J.Degenerative lumbar spinal stenosis.Decompression with and without arthrodesis[J].J Bone Joint Surg Am,1995,77(7):1036-1041.
[6]Yone K,Sakou T.Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis[J].J Spinal Disord,1999,12(1):40-42.
[7]Resnick DK,Choudhri TF,Dailey AT,et al.Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 10:fusion following decompression in patients with stenosis without spondylolisthesis[J].J Neurosurg Spine,2005,2(6):686-691.
[8]Ghogawala Z,Benzel EC,Amin-Hanjani S,et al.Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis[J].J Neurosurg Spine,2004,1(3):267-272.
[9]Rompe JD,Eysel P,Zollner J,et al.Degenerative lumbar spinal stenosis.Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion[J].Neurosurg Review,1999,22(2-3):102-106.
[10]Patel J,Osburn I,Wanaselja A,et al.Optimal treatment for lumbar spinal stenosis:an update[J].Curr Opin Anaesthesiol,2017,30(5):598-603.
[11]Mariconda M,Fava R,Gatto A,et al.Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis:a prospective comparative study with conservatively treated patients[J].J Spinal Disord Tech,2002,15(1):39-46.
[12]Foley KT,Smith MM.Microendoscopic discectomy[J].Tech Neurosurg,1997,3:301-307.
[13]周跃.正确认识经皮椎间孔镜技术[J].中国骨与关节杂志,2013,2(4):181-184.
[14]Costa F,Sassi M,Cardia A,et al.Degenerative lumbar spinal stenosis:analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression[J].J Neurosurg Spine,2007,7(6):579-586.
[15]Miao X,He D,Wu T,et al.Percutaneous endoscopic spine minimal invasive technique for the decompression therapy of thoracic myelopathy caused by ossification of the ligamentum flavum[J].World Neurosurg,2018,114:8-12.
[16]Ruetten S,Komp M,Merk H,et al.Use of newly developed instruments and endoscopes:full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach[J].J Neurosurg Spine,2007,6(6):521-530.
[17]Ruetten S,Komp M,Merk H,et al.Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique:a prospective,randomized,controlled study[J].J Neurosurg Spine,2009,10(5):476-485.
[18]杨进.微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较[J].中华修复重建外科杂志,2013,27(3):262-267.
[19]Ahn J,Tabaraee E,Singh K.Minimally invasive transforaminal lumbar interbody fusion[J].J Spinal Disord Tech,2015,28(6):222-225.
[20]Heo DH,Son SK,Eum JH,et al.Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique:technical note and preliminary clinical results[J].Neurosurg Focus,2017,43(2):E8.
[21]Lee SH,Erken HY,Bae J.Percutaneous transforaminal endoscopic lumbar interbody fusion:clinical and radiological results of mean46-month follow-up[J].BioMed Res Int,2017,2017:3731983.
[22]Nakamura S,Taguchi M.Full percutaneous lumbar interbody fusion:technical note[J].J Neurol Surg A Cent Eur Neurosurg,2017,78(6):601-606.
[23]Wang MY,Grossman J.Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia:initial clinical experience with 1-year follow-up[J].Neurosurg Focus,2016,40(2):E13.
[24]Jacquot F,Gastambide D.Percutaneous endoscopic transforaminal lumbar interbody fusion:is it worth it[J]?Int Orthop,2013,37(8):1507-1510.
[25]Hijikata S.Percutaneous nucleotomy:A new treatment method for lumbar disc herniation[J].J Toden Hosp,1975,5:39-45.
[26]Ahn Y.Percutaneous endoscopic decompression for lumbar spinal stenosis[J].Expert Rev Med Devices,2014,11(6):605-616.
[27]Ruetten S,Komp M,Hahn P,et al.Decompression of lumbar lateral spinal stenosis:full-endoscopic,interlaminar technique[J].Oper Orthop Traumatol,2013,25(1):31-46.
[28]周跃,李长青,王建,等.经皮椎间孔成形术治疗L5/S1神经根管狭窄症[J].中国脊柱脊髓杂志,2009,19(4):345-349.
[29]李振宙,侯树勋,宋科冉,等.经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术的近期随访报告[J].中国骨与关节杂志,2014,8(3):585-589.
[30]刘印,蔡鹏,孔清泉,等.全脊柱内镜治疗合并椎管内骨化腰椎疾患疗效观察[J].脊柱脊髓修复重建,2017,31(11):1326-1333.
[31]Wiltse LL,Berger PE,Mcculloch JA.A system for reporting the size and location of lesions in the spine[J].Spine,1997,22(13):1534-1537.
[32]Lassale B,Morvan G,Gottin M.Anatomy and radiological anatomy of the lumbar radicular canals[J].Anat Clin,1984,6(3):195-201.
[33]Spivak JM.Current concepts review-degenerative lumbar spinal stenosis[J].J Bone Joint Surg Am,1998,80:1053-1066.
[34]Lee CK,Rauschning W,Glenn W.Lateral lumbar spinal canal stenosis:classification,pathologic anatomy and surgical decompression[J].Spine,1988,13(3):313.
[35]Wang Y,Dou Q,Kong Q,et al.Percutaneous endoscopic lumbar decompression for lumbar lateral spinal canal stenosis:classification of lateral region of lumbar spinal canal and surgical approaches[J].World Neurosurg,2018,119:e276-283.
[36]Ahn Y,Lee SH,Park WM,et al.Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or later-al exit zone stenosis[J].J Neurosurg,2003,99(2):320-323.
[37]Gun C,Song HL,Pramod L,et al.Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endo-scope[J].Spine,2008,33(15):E508-515.
[38]Bae JS,Rhee WT,Kim WJ,et al.Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation[J].J Korean Neurosurg Soc,2013,53(3):145-149.
[39]Morimoto M,Higashino K,Katoh S,et al.A rare case of progressive palsy of the lower leg caused by a huge lumbar posterior endplate lesion after recurrent disc herniation[J].Case Rep Orthop,2016,2016:5963924.
[2]胡德新,郑琦,朱博,等.经皮椎间孔镜下选择性减压治疗老年性腰椎管狭窄症的疗效分析[J].中国骨伤,2014,27(3):194-198.
[3]何齐芳.老年性腰椎管狭窄的椎间孔镜治疗分析[J].中华全科医学,2015,13(6):902-905.
[4]徐宝山.经皮椎间孔镜和椎间盘镜治疗腰椎间盘突出症和椎管狭窄症的选择与应用[J].天津医药,2015,43(11):1239-1243.
[5]Grob D,Humke T,Dvorak J.Degenerative lumbar spinal stenosis.Decompression with and without arthrodesis[J].J Bone Joint Surg Am,1995,77(7):1036-1041.
[6]Yone K,Sakou T.Usefulness of Posner’s definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis[J].J Spinal Disord,1999,12(1):40-42.
[7]Resnick DK,Choudhri TF,Dailey AT,et al.Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 10:fusion following decompression in patients with stenosis without spondylolisthesis[J].J Neurosurg Spine,2005,2(6):686-691.
[8]Ghogawala Z,Benzel EC,Amin-Hanjani S,et al.Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis[J].J Neurosurg Spine,2004,1(3):267-272.
[9]Rompe JD,Eysel P,Zollner J,et al.Degenerative lumbar spinal stenosis.Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion[J].Neurosurg Review,1999,22(2-3):102-106.
[10]Patel J,Osburn I,Wanaselja A,et al.Optimal treatment for lumbar spinal stenosis:an update[J].Curr Opin Anaesthesiol,2017,30(5):598-603.
[11]Mariconda M,Fava R,Gatto A,et al.Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis:a prospective comparative study with conservatively treated patients[J].J Spinal Disord Tech,2002,15(1):39-46.
[12]Foley KT,Smith MM.Microendoscopic discectomy[J].Tech Neurosurg,1997,3:301-307.
[13]周跃.正确认识经皮椎间孔镜技术[J].中国骨与关节杂志,2013,2(4):181-184.
[14]Costa F,Sassi M,Cardia A,et al.Degenerative lumbar spinal stenosis:analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression[J].J Neurosurg Spine,2007,7(6):579-586.
[15]Miao X,He D,Wu T,et al.Percutaneous endoscopic spine minimal invasive technique for the decompression therapy of thoracic myelopathy caused by ossification of the ligamentum flavum[J].World Neurosurg,2018,114:8-12.
[16]Ruetten S,Komp M,Merk H,et al.Use of newly developed instruments and endoscopes:full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach[J].J Neurosurg Spine,2007,6(6):521-530.
[17]Ruetten S,Komp M,Merk H,et al.Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique:a prospective,randomized,controlled study[J].J Neurosurg Spine,2009,10(5):476-485.
[18]杨进.微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较[J].中华修复重建外科杂志,2013,27(3):262-267.
[19]Ahn J,Tabaraee E,Singh K.Minimally invasive transforaminal lumbar interbody fusion[J].J Spinal Disord Tech,2015,28(6):222-225.
[20]Heo DH,Son SK,Eum JH,et al.Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique:technical note and preliminary clinical results[J].Neurosurg Focus,2017,43(2):E8.
[21]Lee SH,Erken HY,Bae J.Percutaneous transforaminal endoscopic lumbar interbody fusion:clinical and radiological results of mean46-month follow-up[J].BioMed Res Int,2017,2017:3731983.
[22]Nakamura S,Taguchi M.Full percutaneous lumbar interbody fusion:technical note[J].J Neurol Surg A Cent Eur Neurosurg,2017,78(6):601-606.
[23]Wang MY,Grossman J.Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia:initial clinical experience with 1-year follow-up[J].Neurosurg Focus,2016,40(2):E13.
[24]Jacquot F,Gastambide D.Percutaneous endoscopic transforaminal lumbar interbody fusion:is it worth it[J]?Int Orthop,2013,37(8):1507-1510.
[25]Hijikata S.Percutaneous nucleotomy:A new treatment method for lumbar disc herniation[J].J Toden Hosp,1975,5:39-45.
[26]Ahn Y.Percutaneous endoscopic decompression for lumbar spinal stenosis[J].Expert Rev Med Devices,2014,11(6):605-616.
[27]Ruetten S,Komp M,Hahn P,et al.Decompression of lumbar lateral spinal stenosis:full-endoscopic,interlaminar technique[J].Oper Orthop Traumatol,2013,25(1):31-46.
[28]周跃,李长青,王建,等.经皮椎间孔成形术治疗L5/S1神经根管狭窄症[J].中国脊柱脊髓杂志,2009,19(4):345-349.
[29]李振宙,侯树勋,宋科冉,等.经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术的近期随访报告[J].中国骨与关节杂志,2014,8(3):585-589.
[30]刘印,蔡鹏,孔清泉,等.全脊柱内镜治疗合并椎管内骨化腰椎疾患疗效观察[J].脊柱脊髓修复重建,2017,31(11):1326-1333.
[31]Wiltse LL,Berger PE,Mcculloch JA.A system for reporting the size and location of lesions in the spine[J].Spine,1997,22(13):1534-1537.
[32]Lassale B,Morvan G,Gottin M.Anatomy and radiological anatomy of the lumbar radicular canals[J].Anat Clin,1984,6(3):195-201.
[33]Spivak JM.Current concepts review-degenerative lumbar spinal stenosis[J].J Bone Joint Surg Am,1998,80:1053-1066.
[34]Lee CK,Rauschning W,Glenn W.Lateral lumbar spinal canal stenosis:classification,pathologic anatomy and surgical decompression[J].Spine,1988,13(3):313.
[35]Wang Y,Dou Q,Kong Q,et al.Percutaneous endoscopic lumbar decompression for lumbar lateral spinal canal stenosis:classification of lateral region of lumbar spinal canal and surgical approaches[J].World Neurosurg,2018,119:e276-283.
[36]Ahn Y,Lee SH,Park WM,et al.Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or later-al exit zone stenosis[J].J Neurosurg,2003,99(2):320-323.
[37]Gun C,Song HL,Pramod L,et al.Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endo-scope[J].Spine,2008,33(15):E508-515.
[38]Bae JS,Rhee WT,Kim WJ,et al.Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation[J].J Korean Neurosurg Soc,2013,53(3):145-149.
[39]Morimoto M,Higashino K,Katoh S,et al.A rare case of progressive palsy of the lower leg caused by a huge lumbar posterior endplate lesion after recurrent disc herniation[J].Case Rep Orthop,2016,2016:5963924.
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