经皮脊柱内镜处理双节段腰椎管狭窄症合并椎管内骨化三例报告
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摘要
<正>腰椎管狭窄症(lumbar spinal stenosis,LSS)包括发育性椎管狭窄和继发性椎管狭窄,继发性椎管狭窄原因包括退变性椎管狭窄、椎管内骨化所导致的狭窄、肿瘤性狭窄和外伤性狭窄等。骨化性疾病导致的继发性LSS包括椎体后缘离断(posterior ring apophysis separation,PRAS),后纵韧带、纤维环、黄韧带的骨化或钙化等~([1])。目前经皮脊柱
Objective To explore the advantages, surgical methods and surgical techniques of percutaneous endoscopy in the treatment of dual segmental lumbar spinal stenosis with intraspinal ossification. Methods Percutaneous spinal endoscopy was used to decompress the lateral and central spinal canals in 3 cases, and selective removal of ossified tissue was performed. Results After operation, the clinical symptoms of 3 patients were alleviated, the decompression effects were ideal, and the clinical effects were satisfactory. Conclusions Percutaneous endoscopic surgery is a safe and effective method for the treatment of duel segmental lumbar spinal stenosis with intraspinal ossification. The size, location, extent and segment of ossification in the spinal canal are the main factors affecting the difficulty and risk of endoscopic decompression.
Objective To explore the advantages, surgical methods and surgical techniques of percutaneous endoscopy in the treatment of dual segmental lumbar spinal stenosis with intraspinal ossification. Methods Percutaneous spinal endoscopy was used to decompress the lateral and central spinal canals in 3 cases, and selective removal of ossified tissue was performed. Results After operation, the clinical symptoms of 3 patients were alleviated, the decompression effects were ideal, and the clinical effects were satisfactory. Conclusions Percutaneous endoscopic surgery is a safe and effective method for the treatment of duel segmental lumbar spinal stenosis with intraspinal ossification. The size, location, extent and segment of ossification in the spinal canal are the main factors affecting the difficulty and risk of endoscopic decompression.
引文
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[15]徐宝山,常峰,赵刘军,等.经皮椎间孔入路内镜下治疗腰椎管狭窄症术后再手术的临床报告[J].中华骨科杂志,2018,38(8):485-496.
[16]Kreiner DS,Shaffer WO,Baisden JL,et al.An evidencebased clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis(update)[J].Spine J,2013,13:734-743.
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[18]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.
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[2]Lewandrowski KU.“Outside-in”technique,clinical results,and indications with transforaminal lumbar endoscopic surgery:a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis[J].Int J Spine Surg,2014,8:26.
[3]王玉,孔清泉,宋跃明.精准椎间孔成形减压术治疗腰椎侧隐窝狭窄症的近期疗效分析[J].中国修复重建外科杂志,2017,(11):1334-1340.
[4]Spetzger U,von Schilling A,Winkler G,et al.The past,present and future of minimally invasive spine surgery:a review and speculative outlook[J].Minim Invasive Ther Allied Technol,2013,22(4):227-241.
[5]Telfeian AE,Veeravagu A,Oyelese AA,et al.A brief history of endoscopic spine surgery[J].Neurosurg Focus,2016,40(2):E2.
[6]刘印,蔡鹏,孔清泉,等.全脊柱内窥镜治疗合并椎管内骨化腰椎疾患疗效观察[J].中国修复重建外科杂志,2017,(11):1326-1333.
[7]Wang Y,Dou QY,Yang J,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.
[8]Shirado O,Yamazaki Y,Takeda N,et al.Lumbar disc herniation associated with separation of the ring apophysis:is removal of the detached apophyses mandatory to achieve satisfactory results[J]?Clin Orthop Relat Res,2005,(431):120-128.
[9]Okumura T,Ebisawa K,Ohhira M,et al.Chronic right lower abdominal pain due to lumbar ossification of the posterior longitudinal ligament[J].Am J Gastroenterol,2012,107(1):142-143.
[10]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,2016,10(7):1007-1013.
[11]Hermantin FU,Peters T,Quartararo L,et al.A prospective,randomized study comparing the results of open discectomy withthose of video-assisted arthroscopic microdiscectomy[J].J Bone Joint Surg(Am),1999,81(7):958-965.
[12]Kambin P,Casey K,O’Brien E,et al.Transforaminal arthroscopicdecompression of lateral recess stenosis[J].J Neurosurg,1996,84(3):462-467.
[13]Ahn Y.Percutaneous endoscopic decompression for lumbar spinalstenosis[J].Expert Rev Med Devices,2014,11(6):605-616.
[14]Martin K,Patrick H,Harry M,et al.Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach:prospective2-year results of 74 patients[J].J Spinal Disord Tech,2011,24:281-287.
[15]徐宝山,常峰,赵刘军,等.经皮椎间孔入路内镜下治疗腰椎管狭窄症术后再手术的临床报告[J].中华骨科杂志,2018,38(8):485-496.
[16]Kreiner DS,Shaffer WO,Baisden JL,et al.An evidencebased clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis(update)[J].Spine J,2013,13:734-743.
[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]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.
[19]Osman SG,Nibu K,Panjabi MM,et al.Transforaminal and posterior decompressions of the lumbar spine.A comparative study of stability and intervertebral foramen area[J].Spine,1997,22(15):1690-1695.