L5/S1节段神经根行程与下位关节突的应用解剖研究及其意义
摘要
研究目的:
通过尸体解剖,明确国人L5/S1神经根及下位关节突与周围结构毗邻关系。测量S1“肩三角区”及“腋下三角”等相关数据,研究经L5/S1间隙椎板间入路以脊柱全内镜系统安全直达纤维环进行髓核摘除术的可能性。通过标本模拟及临床试验,探讨该入路的实际可行性
材料和方法:
制作腰椎标本,在L5/S1椎间隙水平观察大体结构,测量L5下关节突上缘距L5椎板下缘弧顶水平线垂直距离;硬膜囊最外侧距离后正中线宽度;硬膜囊最外侧与L5下关节突内侧缘距离;L5神经根与L5椎板弧形下缘最短间距;S1神经根起始点与L5椎板下缘距离;L5/S1椎板间隙S1神经根与硬膜囊最大间距;容纳套管需要咬除外侧最少骨质距离;L5,S1神经根与硬膜囊夹角。在标本上进行工作通道模拟试验,得出模拟套管置入的平均头向倾斜角。利用AutoCAD数位建模精确计算S1神经根“肩三角区”及“腋下三角”面积及咬除部分骨质后的理论最大操作面积。进行统计学分析,得出经L5/S1间隙椎板间入路以脊柱全内镜系统直达纤维环进行髓核摘除术的安全范围。根据结论选择适用微创器械,临床选取典型L5/S1侧方突出患者,按解剖学研究结论以该入路进行实际手术操作。术前、术后1个月及术后3月时进行视觉模拟疼痛评分(VAS)以评价临床疗效
结果:
L5下关节突上缘距L5椎板下缘弧顶水平线垂直距离7.74±0.47mm;硬膜囊最外侧距离后正中线宽度9.03±0.42mm;硬膜囊最外侧与L5下关节突内侧缘距离-0.71±2.02mm;L5神经根与L5椎板弧形下缘最短间距6.36±0.67mm;S1神经根起始点与L5椎板下缘距离-5.16±1.87mm;L5/S1椎板间隙S1神经根与硬膜囊最大间距3.87±1.95mm;容纳套管需要咬除外侧最少骨质距离4.03±0.83mm;L5神经根与硬膜囊夹角39.3±3.0°;S1神经根与硬膜囊夹角19.9±2.9°;模拟套管置入的平均头向倾斜角33.5±2.8°。计算机建模分析得出“腋下三角”平均面积34.96±12.69mm~2;“肩三角区”平均面积18.96±9.04 mm~2;咬除椎板及部分关节突骨质后可达到的“肩三角区”最大面积114.44±21.71 mm~2。根据结果发现于L5/S1椎板间隙存在一可经适度磨削骨质后获得的,可容纳约7mm椎间盘镜系统进入的操作空间根据解剖学研究结果行小样本临床实验,以7毫米外径TESSYS(Joimax)椎间盘镜系统经L5/S1椎板间入路成功在“肩三角区”建立操作通道并顺利完成髓核摘除术,3例患者术后均得到即刻的症状改善,视觉模拟疼痛评分(VAS)在术后,术后1月及术后3月随访时均较术前显著降低,为规模开展临床应用提供了先导依据
结论:
1根据解剖学测量数据分析, S1神经根“肩三角区”最大面积114.44±21.71 mm~2, L5/S1椎板间隙部分磨削椎板外下缘或下关节突骨质后,在此处存在一个可容纳7mm椎间盘镜系统工作套管置入,遂行相关操作的“手术安全区”
2临床上经L5/S1椎间隙S1神经根“肩三角区”入路,以7mm TESSYS(Joimax)内镜系统进行髓核摘除术治疗L5/S1椎间盘突出症在技术上可行
Research objective:
To Applied an anatomical study, definitely described the nexus of the structure around lumbar spinal nerve and articulus in L5/S1. Measured the triangle zone above/under S1 nerve, Calculated the interspace among the L5 and S1 vertebral lamina to resection of nucleus pulposus of lumbar intervertebral disk for Full-Endoscopic system. By the cadaver experiments and clinical surgery, discussed the feasibility in this new surgery channel.
Material and method:
Manufactured lumbar exemplars, Observed the structure of L5/S1, make a careful survey of the apeak distance from the margo superior of L5 processus articularis inferior to the arc vertex horizon of L5 inferior border of vertebral lamina; The width from the lateral duramater capsule to the midline; The distance from the lateral duramater capsule to the margo medialis of articulus; The shortest path from the L5 spinal nerve to the L5 arc inferior border of vertebral lamina; The distance from the origination of the S1 spinal nerve to the inferior border of L5 vertebral lamina; The ultimate range between S1 spinal nerve and duramater capsule in L5/S1 intervertebral space; The distance of the least bone have been removed for cannula;The angle of spinal nerve(L5,S1). Simulation test has been done on body samples, get the average cephalad angle of inclination. An analog study has been done, digit modeling to exact computation operational area by AutoCAD, statistics were performed . Calculated the area of the triangle zone above/under S1 nerve and the maximum operational zone after exorcised bone. Carry on statistics analysis, draw a conclusion from a safe area with resection of nucleus pulposus of L5/S1 lumbar intervertebral disk by Full-Endoscopic system.Selected endoscope which appropriate for surgical operation. In clinical study, sufferer with classic lumbar disc herniation in L5/S1 selected, the actual operation has been done. Evaluate clinical curative effect in preoperative,1 month after surgery and 3 month after surgery by VAS.
Result:
The apeak distance from the margo superior of L5 processus articularis inferior to the arc vertex horizon of L5 inferior border of vertebral lamina is 7.74±0.47mm; The width from the lateral duramater capsule to the midline is 9.03±0.42mm; The distance from the lateral duramater capsule to the margo medialis of articulus is -0.71±2.02mm; The shortest path from the L5 spinal nerve to the L5 arc inferior border of vertebral lamina is 6.36±0.67mm; The distance from the origination of the S1 spinal nerve to the inferior border of L5 vertebral lamina is -5.16±1.87mm; The ultimate range between S1 spinal nerve and duramater capsule in L5/S1 intervertebral space is 3.87±1.95mm; The distance of the least bone have been removed for cannula is 4.03±0.83mm;The angle of spinal nerve(L5 39.3±3.0°,S1 19.9±2.9°). The average cephalad angle of inclination is 33.5±2.8°.
Computer data Modeling Results indicated the area of the triangle zone above/under S1 nerve is 18.96±9.04mm2/34.96±12.69mm2 and the maximum operational zone after exorcised bone is 114.44±21.71 mm2. Discovered according to the result there is an operating space could accommodate the Endo-Disc Endoscope system, about 7mm external diameter, with some bone grinding.
By the outcome of anatomical study, the clinical operation among L5 to S1 vertebral lamina has been done, by 7mm TESSYS endoscopic system. Succeed set up a operational channel in the triangle zone above S1 nerve. Immediate and dramatic symptoms relieved after the operation on 3 patients .The VAS score droped down after operation and follow-up visits. Provided guide basis for a large scale clinical application.
Conclusion:
1 By the anatomical study, the maximum area in the L5/S1 triangle zone above S1 nerve is 114.44±21.71 mm~2,Authors of the paper consider that there is a safe zone for surgical operation and it feasible to accommodate 7mm endoscopic system in the L5/S1 intervertebral space after exorcised bone.
2 In the clinical research, by the operative approach about the triangle zone above S1 nerve, It is maneuverability on the resection of nucleus pulposus of L5/S1 lumbar intervertebral disk in interlaminar approach by 7mm TESSYS(Joimax).
通过尸体解剖,明确国人L5/S1神经根及下位关节突与周围结构毗邻关系。测量S1“肩三角区”及“腋下三角”等相关数据,研究经L5/S1间隙椎板间入路以脊柱全内镜系统安全直达纤维环进行髓核摘除术的可能性。通过标本模拟及临床试验,探讨该入路的实际可行性
材料和方法:
制作腰椎标本,在L5/S1椎间隙水平观察大体结构,测量L5下关节突上缘距L5椎板下缘弧顶水平线垂直距离;硬膜囊最外侧距离后正中线宽度;硬膜囊最外侧与L5下关节突内侧缘距离;L5神经根与L5椎板弧形下缘最短间距;S1神经根起始点与L5椎板下缘距离;L5/S1椎板间隙S1神经根与硬膜囊最大间距;容纳套管需要咬除外侧最少骨质距离;L5,S1神经根与硬膜囊夹角。在标本上进行工作通道模拟试验,得出模拟套管置入的平均头向倾斜角。利用AutoCAD数位建模精确计算S1神经根“肩三角区”及“腋下三角”面积及咬除部分骨质后的理论最大操作面积。进行统计学分析,得出经L5/S1间隙椎板间入路以脊柱全内镜系统直达纤维环进行髓核摘除术的安全范围。根据结论选择适用微创器械,临床选取典型L5/S1侧方突出患者,按解剖学研究结论以该入路进行实际手术操作。术前、术后1个月及术后3月时进行视觉模拟疼痛评分(VAS)以评价临床疗效
结果:
L5下关节突上缘距L5椎板下缘弧顶水平线垂直距离7.74±0.47mm;硬膜囊最外侧距离后正中线宽度9.03±0.42mm;硬膜囊最外侧与L5下关节突内侧缘距离-0.71±2.02mm;L5神经根与L5椎板弧形下缘最短间距6.36±0.67mm;S1神经根起始点与L5椎板下缘距离-5.16±1.87mm;L5/S1椎板间隙S1神经根与硬膜囊最大间距3.87±1.95mm;容纳套管需要咬除外侧最少骨质距离4.03±0.83mm;L5神经根与硬膜囊夹角39.3±3.0°;S1神经根与硬膜囊夹角19.9±2.9°;模拟套管置入的平均头向倾斜角33.5±2.8°。计算机建模分析得出“腋下三角”平均面积34.96±12.69mm~2;“肩三角区”平均面积18.96±9.04 mm~2;咬除椎板及部分关节突骨质后可达到的“肩三角区”最大面积114.44±21.71 mm~2。根据结果发现于L5/S1椎板间隙存在一可经适度磨削骨质后获得的,可容纳约7mm椎间盘镜系统进入的操作空间根据解剖学研究结果行小样本临床实验,以7毫米外径TESSYS(Joimax)椎间盘镜系统经L5/S1椎板间入路成功在“肩三角区”建立操作通道并顺利完成髓核摘除术,3例患者术后均得到即刻的症状改善,视觉模拟疼痛评分(VAS)在术后,术后1月及术后3月随访时均较术前显著降低,为规模开展临床应用提供了先导依据
结论:
1根据解剖学测量数据分析, S1神经根“肩三角区”最大面积114.44±21.71 mm~2, L5/S1椎板间隙部分磨削椎板外下缘或下关节突骨质后,在此处存在一个可容纳7mm椎间盘镜系统工作套管置入,遂行相关操作的“手术安全区”
2临床上经L5/S1椎间隙S1神经根“肩三角区”入路,以7mm TESSYS(Joimax)内镜系统进行髓核摘除术治疗L5/S1椎间盘突出症在技术上可行
Research objective:
To Applied an anatomical study, definitely described the nexus of the structure around lumbar spinal nerve and articulus in L5/S1. Measured the triangle zone above/under S1 nerve, Calculated the interspace among the L5 and S1 vertebral lamina to resection of nucleus pulposus of lumbar intervertebral disk for Full-Endoscopic system. By the cadaver experiments and clinical surgery, discussed the feasibility in this new surgery channel.
Material and method:
Manufactured lumbar exemplars, Observed the structure of L5/S1, make a careful survey of the apeak distance from the margo superior of L5 processus articularis inferior to the arc vertex horizon of L5 inferior border of vertebral lamina; The width from the lateral duramater capsule to the midline; The distance from the lateral duramater capsule to the margo medialis of articulus; The shortest path from the L5 spinal nerve to the L5 arc inferior border of vertebral lamina; The distance from the origination of the S1 spinal nerve to the inferior border of L5 vertebral lamina; The ultimate range between S1 spinal nerve and duramater capsule in L5/S1 intervertebral space; The distance of the least bone have been removed for cannula;The angle of spinal nerve(L5,S1). Simulation test has been done on body samples, get the average cephalad angle of inclination. An analog study has been done, digit modeling to exact computation operational area by AutoCAD, statistics were performed . Calculated the area of the triangle zone above/under S1 nerve and the maximum operational zone after exorcised bone. Carry on statistics analysis, draw a conclusion from a safe area with resection of nucleus pulposus of L5/S1 lumbar intervertebral disk by Full-Endoscopic system.Selected endoscope which appropriate for surgical operation. In clinical study, sufferer with classic lumbar disc herniation in L5/S1 selected, the actual operation has been done. Evaluate clinical curative effect in preoperative,1 month after surgery and 3 month after surgery by VAS.
Result:
The apeak distance from the margo superior of L5 processus articularis inferior to the arc vertex horizon of L5 inferior border of vertebral lamina is 7.74±0.47mm; The width from the lateral duramater capsule to the midline is 9.03±0.42mm; The distance from the lateral duramater capsule to the margo medialis of articulus is -0.71±2.02mm; The shortest path from the L5 spinal nerve to the L5 arc inferior border of vertebral lamina is 6.36±0.67mm; The distance from the origination of the S1 spinal nerve to the inferior border of L5 vertebral lamina is -5.16±1.87mm; The ultimate range between S1 spinal nerve and duramater capsule in L5/S1 intervertebral space is 3.87±1.95mm; The distance of the least bone have been removed for cannula is 4.03±0.83mm;The angle of spinal nerve(L5 39.3±3.0°,S1 19.9±2.9°). The average cephalad angle of inclination is 33.5±2.8°.
Computer data Modeling Results indicated the area of the triangle zone above/under S1 nerve is 18.96±9.04mm2/34.96±12.69mm2 and the maximum operational zone after exorcised bone is 114.44±21.71 mm2. Discovered according to the result there is an operating space could accommodate the Endo-Disc Endoscope system, about 7mm external diameter, with some bone grinding.
By the outcome of anatomical study, the clinical operation among L5 to S1 vertebral lamina has been done, by 7mm TESSYS endoscopic system. Succeed set up a operational channel in the triangle zone above S1 nerve. Immediate and dramatic symptoms relieved after the operation on 3 patients .The VAS score droped down after operation and follow-up visits. Provided guide basis for a large scale clinical application.
Conclusion:
1 By the anatomical study, the maximum area in the L5/S1 triangle zone above S1 nerve is 114.44±21.71 mm~2,Authors of the paper consider that there is a safe zone for surgical operation and it feasible to accommodate 7mm endoscopic system in the L5/S1 intervertebral space after exorcised bone.
2 In the clinical research, by the operative approach about the triangle zone above S1 nerve, It is maneuverability on the resection of nucleus pulposus of L5/S1 lumbar intervertebral disk in interlaminar approach by 7mm TESSYS(Joimax).
引文
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[3] Ejesk?r A, Nachemson A, Herberts P, Lysell E, Andersson G, Irstam L, Peterson LE.Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment. [J] Clin Orthop Relat Res. 1983 Apr;(174):236-42.
[4] Javid MJ, Nordby EJ, Ford LT, Hejna WJ, Whisler WW, Burton C, Millett DK, Wiltse LL, Widell EH Jr, Boyd RJ, Newton SE, Thisted R. Safety and efficacy of chymopapain (Chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomized, double-blind study. [J]JAMA. 1983 May 13;249(18):2489-94.
[5] Hoogland T, Schubert M, Miklitz B, Ramirez A.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. [J]Spine (Phila Pa 1976). 2006 Nov 15;31(24):E890-7.
[6] Sussman BJ. Experimental intervertebral discolysis. A critique of collagenase and chymopapain applications. [J]Clin Orthop Relat Res. 1971 Oct;80:181-90. No abstract available.
[7] Muto M, Avella F. Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection [J]Interv Neuroradiol. 1998 Dec 20;4(4):279-86. Epub 2001 May 15.
[8] Alexandre A, CoròL, Azuelos A, Buric J, Salgado H, Murga M, Marin F, Giocoli H.Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations. [J]Acta Neurochir Suppl. 2005;92:79-82.
[9] Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. [J]Clin Orthop Relat Res. 1986 Jun;(207):37-43.
[10] Hijikata S. Department of Orthopaedic Surgery, Tokyo, Den-ryoku Hospital, Japan. Percutaneous nucleotomy. A new concept technique and 12 years' experience. [J]Clin Orthop Relat Res. 1989 Jan;(238):9-23.
[11] Hausmann B, Forst R. Nucleoscope. Instrumentarium for endoscopy of the intervertebral disc space. [J]Arch Orthop Trauma Surg. 1983;102(1):57-9.
[12] Onik GM.Percutaneous diskectomy in the treatment of herniated lumbar disks. [J]Neuroimaging Clin N Am. 2000 Aug;10(3):597-607
[13] Choy DS, Kaminow IP, Kaplan M, Case RB, Zickel R. Experimental Nd:YAG laser disintegration of methylmethacrylate. Analysis of gaseous products. [J]Clin Orthop Relat Res. 1987 Feb;(215):287-8.
[14] Delamarter RB, Howard MW. Percutaneous lumbar discectomy. Preoper ative and postoperative magnetic resonance imaging [J].JBone Joint Surg. 1995.77:548~584
[15] Kambin P. Arthroscopic microdiskectomy. [J]Mt Sinai J Med. 1991 Mar;58(2):159-64.
[16] Mathews HH, Long BH. Minimally invasive techniques for the treatment of intervertebral disk herniation. [J] Am Acad Orthop Surg. 2002 Mar-Apr;10(2):80-5.
[17] Yeung AT. Minimally Invasive Disc Surgery with the Yeung Endoscopic Spine System (YESS). [J]Surg Technol Int. 2000;VIII:267-277.
[18] Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation. [J]Neurosurg Focus. 1999 Nov 15;7(5):e5.
[19] Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. [J]Oper Orthop Traumatol. 2005 Dec;17(6):641-61.
[20] Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. [J] Neurosurg Spine. 2009 May;10(5):476-85.
[2] Matthew Smuck, MD1, Benoy Benny, MD2, Alice Han, MD1,et al. Epidural Fibrosis Following Percutaneous Disc Decompression with Coblation Technology[J]Pain Physician 2007; 10:691-696
[3] HAROLD S. AMONOO-KUOFI, MOHAMED G. EL-BADAWI,JAMAL A. FATANI AND MASUD M. BUTTLigaments associated with lumbar intervertebral foramina.2. The fifth lumbar level[J]J. Anat. (1988), 159, pp. 1-10
[4] Bruce H. Nowicki, Victor M. Haughton, Timothy A. Schmidt Occult Lumbar Lateral Spinal Stenosis in Neural Foramina Subjected to Physiologic Loading [J]AJNR Am J Neuroradiol 17:1605–1614
[5] H. S. AMONOO-KUOFI The sagittal diameter of the lumbar vertebral canal in normal adult Nigerians[J]J. Anat. (1985), 140, 1, pp. 69-78
[6] G.R HARRISON Topographical anatomy of the lumbar epidural region an in vivo study using computerized axial tomography[J] British Journal of Anaesthesia 83(2):229-34(1999)
[7]吴闻文,李振宙,侯树勋,商卫林侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛中国脊柱脊髓杂志2009年第19卷第6期
[8]许胤李捷一刘芳等离子射频髓核成形术治疗腰椎间盘突出症中国微创外科杂志2008年7月第8卷第7期
[9]蒋林,陈庆等离子体髓核成形术的疗效观察中国骨伤2006年3月第19卷第3期
[10]尹桂斌后路脊柱显微内窥镜椎间盘摘除术术中配合困难与对策Modern Journal ofIntegratedTraditionalChinese andWesternMedicine 2007Dec ,16(34)
[11]任磊王冰全内镜脊柱系统经椎板间入路治疗下腰椎椎间盘突出症的解剖及临床研究[D].长沙:中南大学, 2009.
[12]肖礼祖,熊东林,蓝惠琴腰骶部脊神经后根的解剖与临床应用中国微侵袭神经外科杂志(CMINS) , 2005, 10( 9)
[13]游箭,张绍祥,邱明国腰神经根的薄层断面和CT解剖学研究第三军医大学学报第26卷第2期2004年1月
[14]单云官贺智腰神经通道的解剖特点及其临床意义中国解剖与临床2006年第6卷第1期
[15]郝毅,郑海潮,任国良腰椎间盘高度与椎间孔相关的解剖学研究中国骨伤2006年11月第19卷第11期
[16] Z HA N G N ianchun , Z HOU Yue Current status and advances of minimally invasive techniques for the treatment of lumbar disc diseases[J] Chin J Interv Imaging Ther ,2005 ,Vol 2 ,No 4
[17]宋滇文,贾连顺,陈德玉腰椎间盘突出部位与受压腰骶神经根的异常关系及其原因分析第二军医大学学报2000Jun:21(7)
[18]张西峰腰椎椎间孔镜概念技术和发展第十七届中国内镜医师大会2007年10月
[19]詹俊锋,刘金伟,周兵,椎间盘镜后路下腰椎间盘切除术的应用解剖中国临床解剖学杂志2009年第27卷第2期
[20]鲍达,马远征,白一冰椎间盘压力测定在射频消融髓核成形术中的可行性研究脊柱外科杂志2007年10月,第5卷第5期
[21]林海滨张发惠郑晓晖显微椎间盘镜后路手术的应用解剖与临床研究中华外科杂志2003年9月第41卷第9期
[22] Torun F, Dolgun H, Tuna H Morphometric analysis of the roots and neural foramina of the lumbar vertebrae. [J] Surg Neurol. 2006 Aug;66(2):148-51; discussion 151.
[23] Ebraheim NA, Miller RM, Xu R, Yeasting RA. The location of the intervertebral lumbar disc on the posterior aspect of the spine. [J]Surg Neurol. 1997 Sep;48(3):232-6.
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[1] VALLS J, OTTOLENGHI CE, SCHAJOWICZ F. Aspiration biopsy in diagnosis of lesions of vertebral bodies. [J]Am Med Assoc. 1948 Feb 7;136(6):376-82.
[2] Smith S, Leibrock LG, Gelber BR, Pierson EW. Acute herniated nucleus pulposus with cauda equina compression syndrome following chemonucleolysis. Report of three cases. [J] Neurosurg. 1987 Apr;66(4):614-7.
[3] Ejesk?r A, Nachemson A, Herberts P, Lysell E, Andersson G, Irstam L, Peterson LE.Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment. [J] Clin Orthop Relat Res. 1983 Apr;(174):236-42.
[4] Javid MJ, Nordby EJ, Ford LT, Hejna WJ, Whisler WW, Burton C, Millett DK, Wiltse LL, Widell EH Jr, Boyd RJ, Newton SE, Thisted R. Safety and efficacy of chymopapain (Chymodiactin) in herniated nucleus pulposus with sciatica. Results of a randomized, double-blind study. [J]JAMA. 1983 May 13;249(18):2489-94.
[5] Hoogland T, Schubert M, Miklitz B, Ramirez A.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. [J]Spine (Phila Pa 1976). 2006 Nov 15;31(24):E890-7.
[6] Sussman BJ. Experimental intervertebral discolysis. A critique of collagenase and chymopapain applications. [J]Clin Orthop Relat Res. 1971 Oct;80:181-90. No abstract available.
[7] Muto M, Avella F. Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection [J]Interv Neuroradiol. 1998 Dec 20;4(4):279-86. Epub 2001 May 15.
[8] Alexandre A, CoròL, Azuelos A, Buric J, Salgado H, Murga M, Marin F, Giocoli H.Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations. [J]Acta Neurochir Suppl. 2005;92:79-82.
[9] Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. [J]Clin Orthop Relat Res. 1986 Jun;(207):37-43.
[10] Hijikata S. Department of Orthopaedic Surgery, Tokyo, Den-ryoku Hospital, Japan. Percutaneous nucleotomy. A new concept technique and 12 years' experience. [J]Clin Orthop Relat Res. 1989 Jan;(238):9-23.
[11] Hausmann B, Forst R. Nucleoscope. Instrumentarium for endoscopy of the intervertebral disc space. [J]Arch Orthop Trauma Surg. 1983;102(1):57-9.
[12] Onik GM.Percutaneous diskectomy in the treatment of herniated lumbar disks. [J]Neuroimaging Clin N Am. 2000 Aug;10(3):597-607
[13] Choy DS, Kaminow IP, Kaplan M, Case RB, Zickel R. Experimental Nd:YAG laser disintegration of methylmethacrylate. Analysis of gaseous products. [J]Clin Orthop Relat Res. 1987 Feb;(215):287-8.
[14] Delamarter RB, Howard MW. Percutaneous lumbar discectomy. Preoper ative and postoperative magnetic resonance imaging [J].JBone Joint Surg. 1995.77:548~584
[15] Kambin P. Arthroscopic microdiskectomy. [J]Mt Sinai J Med. 1991 Mar;58(2):159-64.
[16] Mathews HH, Long BH. Minimally invasive techniques for the treatment of intervertebral disk herniation. [J] Am Acad Orthop Surg. 2002 Mar-Apr;10(2):80-5.
[17] Yeung AT. Minimally Invasive Disc Surgery with the Yeung Endoscopic Spine System (YESS). [J]Surg Technol Int. 2000;VIII:267-277.
[18] Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation. [J]Neurosurg Focus. 1999 Nov 15;7(5):e5.
[19] Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. [J]Oper Orthop Traumatol. 2005 Dec;17(6):641-61.
[20] Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. [J] Neurosurg Spine. 2009 May;10(5):476-85.