我们要感谢科学团队成员京和金银在获取全文文章和管理数字作品方面提供帮助。

该议定书遵循 Nanoori 医院人类研究伦理委员会的指导方针。由于腰椎间盘突出症, 单侧下肢神经根病患者获得书面知情同意。排除标准是存在节段不稳定, 腰椎滑脱 (超过1级), 并存在严重的脊柱狭窄。
1. 患者位置和皮肤标记
<ol><li>将患者置于阴性手术台上的俯卧位, 脊柱轻微屈曲。 注: 患者手术适应症如下: 顽固性, 经常单侧神经根神经根抗保守措施 (至少6–8周), 有或没有相关的轴向背部疼痛, 身体检查的积极张力标志,与神经根病相关的放射学证据证实 MRI 研究。</li>
	<li>标记脊柱中线, 以及髂嵴的程度, 用标记笔在图像增强器下。</li>
	<li>使用手动反评估方法标记椎旁皮肤入口点沿光盘空间中心的位置6: 检查背部肌肉和腹部肌肉之间的界限。将皮肤入口点标记为中间盘中的这一边缘, 无论是在 Antero 后 (AP) 还是侧向 X 射线。</li>
</ol>2. 局部麻醉和切口
<ol><li>渗透皮下局部麻醉 (2 毫升1% 利多卡因) 在入口点, 然后执行皮肤切口约1厘米和渗透的弹道与局部麻醉 (3 毫升1% 利多卡因) 通过23克针。</li>
	<li>通过皮肤切口在25–35°角度插入一根18克的脊柱到水平。</li>
	<li>通过筋膜和背部肌肉在图像增强器下的针。然后, 将针停靠在 Kambin 的三角形上, 靠近椎间盘。 注意: Kambin 的三角形存在于圆盘的后外侧。斜边为出神经根, 基底为下椎骨的优势边界, 高度为卵泡膜囊/穿过神经根。</li>
	<li>在图像增强器下注射1.5 毫升的对比染料, 检查 Kambin 三角形的游离硬膜外空间。在 Kambin 的三角形中注射8–10毫升1% 利多卡因, 然后在初始注射后用1.6% 利多卡因 (8 毫升2% 利多卡因和2毫升生理盐水加0.05 毫升肾上腺素) 的增压注射, 在椎间孔空间提供局部麻醉。</li>
</ol>3. 唱片
<ol><li>插入针在盘空间透视和执行唱片注射2毫升0.8% 靛蓝胭脂红混合与对比。</li>
</ol>4. 插入内窥镜
<ol><li>通过针插入盘空间中的导丝, 然后取出针。</li>
	<li>通过插入的导丝, 在 Kambin 的三角形中滑动闭孔并将其锚定在圆盘空间的表面上。</li>
	<li>插入工作套管通过闭孔, 然后, 将内窥镜引入 Kambin 的三角形。 注: 工作套管为斜面型, 外径为8毫米。内窥镜有一个30°视角, 7.3 毫米外径, 4.7 毫米直径工作通道, 251 毫米的总长度。整个过程使用恒定的盐水灌溉执行。</li>
</ol>5. 手术方法
<ol><li>在进入光盘之前, 通过内窥镜观察 Kambin 三角形的硬膜外脂肪和软组织 (图 1A)。</li>
	<li>用射频凝固清除环状软组织和血管。用环形切割机进行环形开窗, 在内镜视野下进入环隙。 注意: 为了避免在方法过程中对退出和遍历神经根造成任何伤害, 手术将继续由患者持续反馈。</li>
	<li>通过在 fenestrated 环中插入套管的锥型, 获得硬膜外空间和圆盘空间的半半视图。 注意: 在半半和一半的背半部, 后纵韧带, 硬膜外空间, 和穿过神经根和硬脑膜可以看到。在腹侧半部, 可看到后纵韧带的环状和椎间盘腹侧。</li>
	<li>将工作套管向下杠杆, 以达到精确的半和半视图7 (图 2A和2B)。 注: 使用锥型工作套管, 初学者不容易操作的退出神经根安全, 所以也可以使用圆形工作套管 (图 3)。</li>
</ol>6. 目标 Fragmentectomy
<ol><li>充分减压后突出的椎间盘, 改变工作的轨迹, 对症状盘区。 注意: 工作通道指向的是下移盘中的 suprapedicular 凹槽、高渠道受损圆盘的硬膜外空间和高级迁移盘中的椎间孔空间 (图 3)。</li>
	<li>通过检查游离漂浮的硬脑膜囊、出根和穿过根, 并通过旋转工作通道和内窥镜释放硬膜外空间, 以此确认椎间盘的所有游离碎片。 注: 所有患者在手术后的第二天接受 MRI 检查 (图 4和图 5)。</li>
</ol>

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作者没有什么可透露的。

本研究基于对我院184例腰椎间盘疾病患者的前瞻性分析。在所有病例中都进行 X 线成像、计算机断层扫描 (CT) 和磁共振成像 (MRI), 以确认诊断和排除其他病理。CT 和 MRI 扫描显示的结果与神经系统检查相关。正确诊断后, 患者在 PETLD 的移动外技术上进行手术。排除标准是出现节段不稳定, 超过1级的腰椎滑脱, 以及存在明显的脊柱狭窄。所有患者均获得书面知情同意。
上述技术的关键步骤是精确放置孔内的工作套管, 并获得孔和圆盘空间的半半视图。下一关键步骤是引导孔内的工作套管朝向目标碎片。这里描述的技术不同于早先描述的舒伯特和 Hoogland4所需的扩孔技术。在当前协议中, 工作套管放置在 Kambin 的三角形中 (图 1), 以允许移动到目标片段的每个位置。在这项技术中, 硬膜外脂肪和软组织结构可以充分可视化之前进入光盘空间。进入视盘空间是另一个关键步骤, 防止任何进一步的盘伤害和移出光盘碎片。根据目标片段的位置, 在椎间、椎间孔或 suprapedicular 路线之后, 是下一个关键步骤6。因此, foraminoplasty 只需要在病人的一个小的子集。
所描述的技术比以前描述的技术有几个优点。最主要的是在脱垂盘位置的广泛变化, 是有效地管理的移动外技术。光盘的不同位置包括中央, paracentral, 椎间孔, 远侧向上和向下迁移, 以及那些与运河妥协。6最初的着陆在孔之内是最关键的部分并且给外科医生一个整体看法孔。根据脱垂盘的需要, 给出了不同方向的套管移动的灵活性。另一个主要的优点是在视觉下进入环形, 因此避免了对圆盘的进一步损坏或通过盲穿刺来移去碎片。与内出技术相比, 孔内结构的视觉效果总是比较好的, 挤出圆盘碎片早期处理, 套管的调动更舒适, 并能处理上、向下迁移的光盘20,21。外来技术允许专门针对片段, 因此 foraminoplasty 只需要在选定的病人。在这项技术操作的190个水平中, 仅有46例患者需要进行钻探 (25%)。Foraminoplasty 主要需要在那些有显著下降的移民和那些与运河妥协。部分的上级关节过程和上半部分的椎弓根被钻孔, 以创造足够的空间。使用弯钳和探针进一步帮助移除迁移片段。我们成功地利用了移动外部的方法来管理所有不同类型的腰椎间盘椎间盘。使用移动外部技术值得特别提及, 当用于向下迁移的光盘, 这通常被认为是难以内窥镜。作者管理了38名有向下迁移片段的病人。其中, 在23例 (60.5%) 和其余15例患者 (39.5%) 中, 根据 Macnab 标准取得了良好的疗效。
我们没有发现对本文所介绍的技术有什么重大限制。当然, PETLD 的外部技术有一个初学者需要考虑的学习曲线。与以前的孤立报告中提到的神经血管和韧带结构损伤的风险在外部技术7,8, 我们的经验表明, 外在技术与选择性 foraminotomy与前面描述的外技术相比, 同样安全有效。这种技术不同于早先描述的外部技术, 不完全取决于扩大孔4,27,28。早先被描述的外在技术由舒伯特和 Hoogland 提到孔的扩大作为一个通常组分在所有患者4。这里提出的技术重点是准确地放置套管向目标片段, 因此需要扩大的选择病人的孔。因此, 该技术为大孔及其周围结构提供了更好的整体观。广泛的圆盘下垂, 包括运河妥协, 有效地管理这一技术证实, 没有禁忌的外部技术。
所述技术的未来应用范围广泛的腰椎间盘突出症。即使是高管折衷和向下迁移的椎间盘的患者, 也可以通过 PETLD 进行适当的管理。因此, 技术的地平线正在上升。通过精确定位光盘的压缩元件, 该技术可以在孔内提供最佳的视觉效果, 并有助于达到所期望的结果。
PETLD 的移动外技术可用于处理所有类型的腰椎间盘突出症, 包括高管折衷, 由于工作套管的流动性向靶点。它有一个学习曲线, 需要彻底了解脊柱解剖。该技术可应用于各类腰椎间盘突出症及腰椎各层面。

fChronic 腰痛和腿部疼痛是任何社会中常见的疾病。治疗退行性腰椎间盘疾病的方法不断发展。医疗设备已经广泛, 从开放性手术和固定到 microlumbar 椎间盘摘除术, 现在的内窥镜路线1,2,3,4。最初由 Parvez Kambin 建议的经神经孔通路, 现在逐渐成为护理标准5,6,7。全内镜脊柱手术的优点是减少软组织解剖, 减少失血, 缩短入院天数, 早期功能恢复, 提高生活质量8。
舒伯特和 Hoogland4所给出的传统的 PETLD 方法, 涉及在孔中引入工作套管, 然后使用铰刀将孔扩大。这里所提到的外来方法的新技术背后的基本原理是, 它并不完全取决于在所有情况下扩大孔。该技术的重点是在孔内的工作套管的精确放置, 然后引导套管的运动向目标片段, 在内窥镜视野9,10。解剖上, 有三条不同的路线进入经神经孔空间, 如果有效使用, 经皮内窥镜脊柱手术与外技术可应用于更广泛的腰椎间盘突出症。中央、paracentral、高管受损的乳酸脱氢酶 (LDH) 由椎间隙通路接触;椎间孔、优迁移和远侧 ldh 由椎间孔路线接近, 相接迁移的 ldh 由 suprapedicular 路线6接近。这项技术的优点是它保留了正常的解剖结构, 盘损伤较小, 硬膜外暴露是容易的, 并操作套管在孔不难。所描述的技术与前面的方法不同, 因为它提供了孔内结构的精确视觉, 重点放在孔内套管的准确放置, 而不是扩大孔。该技术同样安全, 作为内出技术, 并提供了一个简单的处理结构, 特别是挤压碎片。本研究的目的是证明这一新方法的通用性, 以管理不同类型的椎间盘脱垂为中心, paracentral, 椎间孔, 远侧, 上下迁移, 以及在高渠道妥协的情况下。然而, 这项技术需要更长的学习曲线, 所以初学者在学习时要有耐心。

<table border="0" cellpadding="0" cellspacing="0" width="651">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">Contrast dye injection</td>
			<td style="width:347px;">Iobrix injection, Taejoon pharm,Seoul, Korea</td>
			<td align="right" style="width:65px;">S.No. 1</td>
			<td style="width:64px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">0.8% indigo carmine</td>
			<td>Carmine, Korea United Pharmaceutical, Yoenki, Korea</td>
			<td align="right">S.No. 2</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">30 degree endoscope</td>
			<td>Joimax GmbH, Germany</td>
			<td align="right">S.No. 3</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Radiofrequency coagulator</td>
			<td>Elliquence, New York, USA</td>
			<td align="right">S.No. 4</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Drill</td>
			<td>Primado 2 NSK, Tochigi, Japan</td>
			<td align="right">S.No. 5</td>
			<td></td>
		</tr>
	</tbody>
</table>

a mobile outside-in technique of transforaminal lumbar endoscopy for lumbar disc herniations

经皮内窥镜经神经孔腰椎间盘摘除术 (PETLD) 现在已成为治疗腰椎间盘疾病的标准。有两种技术, 用于引进一个工作套管的光盘-内外内外。本前瞻性研究的目的是描述一种新颖的移动外型方法处理不同类型盘脱垂的技术问题。184例腰椎间盘突出症并发单侧下肢神经根病患者, 在 PETLD 的移动外技术上进行手术。根据他们的椎间盘脱垂类型、视觉模拟量表 (输精管) 腿部疼痛评分、Oswestry 残疾指数 (ODI) 和 Macnab 标准, 对其临床结局进行评估。减压的完整性记录了术后磁共振成像。患者平均年龄为 50 16 岁, 男性/女性比例为2:1。平均随访时间为 19 6 月。共有190腰椎水平 (L1-L2: n = 4, L2-L3: n = 17, L3-L4: n = 27, L4-5: n = 123, 和 L5-S1: n = 19)。分成类型, 患者分布中央: n = 14, paracentral: n = 74, 椎间孔: n = 28, 远的侧向: n = 13, 优越迁移: n = 8, 下等迁移: n = 38, 并且高运河妥协: n = 9。平均手术时间为 35 12 (25-56) 分钟, 平均住院天数为1.2 岁 (1–3) 天。腿部疼痛的输精管评分从7.5 到1提高到 1.7, 0.9。ODI 改进了从 70 8.3 到 23 @ 5。根据 Macnab 标准, 75 例患者 (40.8%) 疗效良好, 104 例 (56.5%) 患者疗效良好, 5 例患者 (2.7%) 结果合理。复发 (包括早和晚) 在190个水平被看见了15在操作了在 (7.89%)。本文提出了一种新颖的外入方法, 它依赖于在孔内的精确着陆, 以移动的方式, 不完全取决于扩大的孔。它在应用上更具通用性, 在处理各种椎间盘脱垂方面也有用处, 即使在严重的运河折衷和高迁徙中也是如此。

结果评估:
手术的结果由输精管疼痛评分11, ODI12, Macnab 标准13测量。这些测量在术前和随访期间 (手术后1周, 手术后3月, 最后随访)。
基线特征:
研究组平均年龄为 50 16 岁, 男性/女性比例为2:1。这项研究的平均随访时间为 19 6 月。共190腰椎水平的手术 (L1–L2: n = 4, L2–L3: n = 17, L3–L4: n = 27, L4–L5: n = 123, 和 L5–S1: n = 19)。分成类型, 患者分布中央: n = 14, paracentral: n = 74, 椎间孔: n = 28, 远的侧向: n = 13, 优越迁移: n = 8, 下等迁移: n = 38, 并且高运河妥协: n = 9。表 1总结了人口统计学数据和基线特征, 包括术前 MRI 特征和术中发现。平均手术时间为 35 12 (25–56) 分钟, 平均住院天数为 1.2 @ 0.5 (1–3) 天。
临床结果:
腿部疼痛的输精管评分从7.5 到1提高到 1.7, 0.9。ODI 改进了从 70 8.3 到 23 @ 5。在手术后立即注意到输精管评分和 ODI 的改善, 并在随访中保持统计学意义 (表 2, 图 6)。在几乎所有的病人中, 马达的改善都完成了。根据 Macnab 标准, 75 例患者 (40.8%) 疗效良好, 104 例 (56.5%) 患者疗效良好, 其余5例 (2.7%) 均有较好的疗效。复发在 190 个水平被看见了 15 在作的 ( 7 . 89% ) ; 在这些情况下 , 11 例患者接受了修订 PETLD ( 5 . 98% ) , 4 例患者进行了开放性 foraminotomy ( 2 . 17% ) 。
背部疼痛和腿部疼痛已经困扰人类多年。腰椎间盘突出症的外科治疗方法正在发生变化。经皮内窥镜脊柱手术的主要优点是尽可能保持正常的解剖结构, 从而保持手术前的功能状态。由于在全球6、7、14、15、16等地开展了广泛的工作, PETLD 在过去几年中取得了重要的地位。与椎间盘切除术相比, 早期的结果是有希望的, 早期动员, 减少失血, 小切口, 更好的止痛, 和更好的长期结果, 良好的生活质量6,7,17,18. 经神经孔路线的手术医疗设备相当广泛, 几乎所有类型的椎间盘都是中央、paracentral、椎间孔、远侧、以及由它管理的优越和低等迁移光盘, 效率19,20,21,22,23。
在以前的研究中, Tzaan 在89% 的患者中表现出良好或优秀的结果1, 而杨和邹族在307例患者经神经孔手术后达到90% 的患者满意率15。同样, Ruetten等。成功的79% 的内窥镜 discectomies 患者复发腰椎间盘突出症24。在 2013年, 贾斯珀等人的研究集中在老年患者的腰椎间盘疾病, 由经神经孔内窥镜管理19。结果在71.4% 根据 Macnab 标准是好的, 并且输精管得分从9.2 在手术前期间减少了到2.63 在6月随访。所描述的外技术的复发率, 平均随访 19, 6 月是7.89%。这在以前报告的复发率的范围很好是 5-18%14,25,26。舒伯特和 Hoogland 在611例4的研究人群中显示复发率为 3.6%, 而 Hoogland等。14已表明, 复发率可能因随访的程度而异。虽然在他们的研究中, 7 的262例患者在手术后3月内早期复发, 到手术后2年结束时, 复发病例增加到 11 (4.62%)。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/57999/57999fig1.jpg"> 图 1: 术中内镜视野中的外经神经孔方法.(a) 本小组显示了在经神经孔的外部方法下的第一个内镜视野, 与 (A) 面和 (b) 在椎间盘上的孔上的软组织。(b) 本小组在经神经孔空间清除后使用射频显示内窥镜视图, 与 (a) 椎间孔韧带, (B) suprapedicular 切口区, (c) 颅椎间孔区, (d) 硬膜外区和 (e) 椎间盘。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/57999/57999fig2.jpg"> 图 2: 经神经孔手术中套管放置的说明性手术视图.(A) 本小组显示套管在经神经孔方法中的初步放置。(B) 本小组显示工作套管的向下扳, 以达到半半的视野。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/57999/57999fig3.jpg"> 图 3: 经皮内窥镜经神经孔腰椎间盘摘除术的手术观点.(A) 本小组显示 suprapedicular 路线。(B) 本小组显示椎间线。(C) 本小组显示椎间孔路线。(D) 本小组展示了远侧圆盘的圆套管放置。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig3large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/57999/57999fig4.jpg"> 图 4: 具有低迁移盘的患者的 mr 图像.(A) 这些是术前 T2-weighted 矢状和轴向图像, 显示 L4–L5 水平高的低迁移盘脱垂, 右侧有显著的压迫。(B) 这些是术后 T2-weighted 矢状和轴向图像, 显示完整的片段去除使用外技术。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/57999/57999fig5.jpg"> 图 5: 一名患有高管妥协的病人的图像.(A) 这些是术前 T2-weighted 矢状和轴向图像, 显示高管折衷与椎间盘脱垂在 L3–L4 水平。(B) 这些是术后 T2-weighted 矢状和轴向图像显示解压卵泡膜囊与完整的片段清除。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig5large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/57999/57999fig6.jpg"> 图 6: 经神经孔内窥镜外技术的临床效果.y轴表示视觉模拟刻度 (VAS) 和 Oswestry 残障指数 (ODI) 的分数, 而x轴表示时间段。(A) 此图显示了腿部疼痛的输精管。(B) 该图显示了 ODI。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/57999/57999fig6large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td>因素</td>
			<td>患者 (n = 184)</td>
		</tr>
<tr>
<td>年龄 (年)</td>
			<td>50±16 (15-86) *</td>
		</tr>
<tr>
<td>男/女比例</td>
			<td>2:01</td>
		</tr>
<tr>
<td>涉及的级别 (n=190)</td>
			<td></td>
		</tr>
<tr>
<td>L1-L2</td>
			<td>4 (2.1) ǂ</td>
		</tr>
<tr>
<td>L2-L3</td>
			<td>17 (9) ǂ</td>
		</tr>
<tr>
<td>L3-L4</td>
			<td>27 (14.2) ǂ</td>
		</tr>
<tr>
<td>L4-L5</td>
			<td>123 (64.7) ǂ</td>
		</tr>
<tr>
<td>L5-S1</td>
			<td>19 (10) ǂ</td>
		</tr>
<tr>
<td>盘脱垂型</td>
			<td></td>
		</tr>
<tr>
<td>中央</td>
			<td>15 (7.9) ǂ</td>
		</tr>
<tr>
<td>Paracentral</td>
			<td>75 (39.5) ǂ</td>
		</tr>
<tr>
<td>椎间孔</td>
			<td>29 (15.3) ǂ</td>
		</tr>
<tr>
<td>远侧</td>
			<td>16 (8.4) ǂ</td>
		</tr>
<tr>
<td>高级迁移</td>
			<td>8 (4.2) ǂ</td>
		</tr>
<tr>
<td>下级迁移</td>
			<td>38 (20) ǂ</td>
		</tr>
<tr>
<td>高运河妥协</td>
			<td>9 (4.7) ǂ</td>
		</tr>
<tr>
<td>后续行动 (月)</td>
			<td>19±6 (9-29) *</td>
		</tr>
<tr>
<td>MacNab 标准</td>
			<td></td>
		</tr>
<tr>
<td>非常好</td>
			<td>75 (40.8) ǂ</td>
		</tr>
<tr>
<td>好</td>
			<td>104 (56.5) ǂ</td>
		</tr>
<tr>
<td>公平</td>
			<td>5 (2.7) ǂ</td>
		</tr>
<tr>
<td>复发</td>
			<td>15 (7.89) ǂ</td>
		</tr>
<tr>
<td>钻孔要求</td>
			<td>46 (24.2%)</td>
		</tr>
<tr>
<td colspan="2">* 所有值均表示为 "标准偏差" (范围)。ǂ所有表示为数字的值 (%)。</td>
		</tr>
</tbody></table>表 1: 移动外技术的患者特点。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td>参数</td>
			<td>Preop</td>
			<td>张贴作品</td>
			<td>P 值</td>
			<td>3月</td>
			<td>P 值</td>
			<td>最后跟进</td>
			<td>Pvalue</td>
		</tr>
<tr>
<td>视觉模拟量表 (VAS)</td>
			<td>7.51±0.99</td>
			<td>2.76±0.71</td>
			<td>< 0.0001</td>
			<td>1.96±0.83</td>
			<td>< 0.0001</td>
			<td>1.73±0.85</td>
			<td>< 0.0001</td>
		</tr>
<tr>
<td>Oswestry 残疾指数 (ODI)</td>
			<td>69.66±8.25</td>
			<td>34.41±5.32</td>
			<td>< 0.0001</td>
			<td>26.47±5.56</td>
			<td>< 0.0001</td>
			<td>23.15±5.83</td>
			<td>< 0.0001</td>
		</tr>
</tbody></table>表 2: 视觉模拟量表和 Oswestry 残疾指数的术前及术后价值的比较分析。

Watch this Scientific Journal Video about A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations at JoVE.com

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

在这里, 我们提出了一种新的经神经孔内窥镜下椎间盘摘除术椎间盘的协议。详细介绍了该技术的技术方面、使用范围广、治疗结果184例。

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

a-mobile-outside-technique-transforaminal-lumbar-endoscopy-for-lumbar

Nanyang Technological University

Research

JoVE Journal

Medicine

11.7K 次观看.  Nanoori Hospital. 在这里, 我们提出了一种新的经神经孔内窥镜下椎间盘摘除术椎间盘的协议。详细介绍了该技术的技术方面、使用范围广、治疗结果184例。

视频: A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods of FMT administration have been reported in the literature including nasogastric tube, upper endoscopy, enema and colonoscopy. FMT via colonoscopy yields excellent cure rates and is also well tolerated. We have found that patients find this an acceptable and tolerable mode of delivery. At our Center, we have initiated a fecal transplant program for patients with recurrent or refractory CDI. We have developed a protocol using an iterative process of revision and have performed 24 fecal transplants on 22 patients with success rates comparable to the current published literature. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool maximizes therapeutic success. Here we detail each step of the FMT protocol that can be carried out at any endoscopy center with a high degree of safety and success.

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation via colonoscopy is a safe and effective treatment for recurrent and refractory C.difficile infection. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool during the colonoscopy will maximize therapeutic success.

通过结肠镜检查粪便菌群移植治疗复发性<em&gt;温度。难辨</em&gt;感染

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods ...

科研

医学

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration have been developed. The ideal animal model should closely mimic the human intervertebral disc with regard to morphology, biomechanical properties and the absence of notochordal cells. The sheep lumbar intervertebral disc model fulfils these criteria. We present an ovine model of intervertebral disc degeneration utilizing a drill bit injury through a lateral retroperitoneal approach. The lateral approach significantly reduces the incision and potential morbidity associated with the traditional anterior approach to the ovine spine. Utilization of a drill-bit method of injury affords the ability to produce a consistent and reproducible injury, of precise dimensions, that initiates a consistent degree of intervertebral disc degeneration. The focal nature of the annular and nucleus pulposus defect more closely mimics the clinical condition of focal intervertebral disc herniation. Sheep recover rapidly following this procedure and are typically mobile and eating within the hour. Intervertebral disc degeneration ensues and sheep undergo necropsy and subsequent analysis at periods from eight weeks. We believe that the drill bit injury model of intervertebral disc degeneration offers advantages over more conventional annular injury models.

Intervertebral disc degeneration is a significant contributor to back pain and a leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration exist. We demonstrate an ovine model of intervertebral disc degeneration, utilizing a drill bit, which achieves a consistent disc injury and reproducible level of disc degeneration.

Ovine Lumbar椎间盘退变模型利用横向腹膜后位钻伤

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the lower extremities, hyperhidrosis, etc. It is commonly practiced to position the puncture needle tip in front of the anterior fascia of the psoas major muscle and inject the inactivating agent around the sympathetic trunk, which is defined as conventional CLS. Although relatively rare, ureteropelvic damage is the most frequently reported complication of conventional CLS and can cause serious harm to patients. We found that injecting the inactivating agent behind the anterior fascia, which only targets gray rami communicantes, helped achieve therapeutic efficacy in&#160;vasodilation, sweat reduction, and pain relief comparable to conventional CLS, and serious complications were largely reduced. We define this procedure as selective CLS. Here, we present a protocol of selective CLS. The precise needle tract and accurate evaluation of the spreading of the contrast agent are critical to ensure that the drug is injected behind the anterior fascia of the psoas major muscle. The needle tip is at approximately one-third the dividing line of the vertebral body in the lateral view of a lumbar X-ray. The contrast is mainly confined around the needle tip and spreads outward and downward along the psoas muscle fibers. In this way, the anterior fascia provides a natural barrier for the ureteropelvic area, and the psoas major muscle provides a natural barrier for the lumbar nerve root. There are several highlights of this article, including 1) a detailed description of the selective CLS procedures, 2) an explanation of the anatomical basis for the implementation of selective CLS, and 3) an explanation of the differences between selective and conventional CLS.

We present a protocol for selective chemical lumbar sympathectomy (CLS), which inactivates only gray rami communicantes and not the sympathetic trunk. Selective CLS can help achieve therapeutic efficacy in vasodilation, sweat reduction, and pain relief that are comparable to conventional CLS, and serious complications, particularly ureteropelvic damages, can be reduced.

选择性化学腰椎交感神经切除术中灰色拉米关节的靶向性

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the ...

Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion surgery to obtain results about altered variables of gait and posture. These observed changes can then be correlated with the patient-reported outcome measure of pain relief. The rasterstereographic device projects lines of parallel light onto the surface of the tested subject&#39;s back. The deformation of these lines is recognized by the device. From these data, a special software then generates a 3-D profile based on the principle of triangulation. With an inaccuracy of only 0.2 mm it can measure changes in posture at very high precision. Gait and stance parameters are recorded using a treadmill equipped with an electric sensor mat that contains 10,200 miniature force sensors in the registering zone under the belt. Initial walking speed on the treadmill is 0.5 km/h. Speed is then gradually increased by increments of 0.1 km/h until each subject reaches his or her individual maximum well tolerable walking speed. At this speed, parameters are recorded during a 20 s measurement interval. Subjects are tested barefoot and without holding a handrail. Among various other parameters, stride width, step length, stance phase and foot rotation are measured. Both methods used reportedly have a high intra- and inter-observer reliability. The advantage of these highly accurate techniques is that they offer an objective and very detailed perspective on changes in the patient&#39;s posture and gait. Due to the amount of data generated, these techniques are, however, not so much suitable for everyday routine use, but rather interesting to scientifically evaluate long term alterations in posture and gait in patients like for example after lumbar fusion surgery.

Here, we present a protocol to analyze the posture and the gait of patients after lumbar fusion surgery by means of high-resolution video rasterstereography and a treadmill equipped with an integrated sensor mat. Allowing critical functional postoperative evaluation on a less subjective level may enhance accuracy and reliability of indication for surgery.

视频栅格立体成像和跑步机步态分析对腰椎融合手术后患者体型和步态剖面的评价

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

全内窥镜隔离区技术治疗腰椎间盘突出症

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

3D Printing Model of a Patient's Specific Lumbar Vertebra

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical field of view but also protect the patient&#39;s spinal nerves from injury. Digital models play an important role in the pre-and intra-operation of SDR, because they can not only make doctors more familiar with the anatomical structure of the surgical site, but also provide precise surgical navigation coordinates for the manipulator. This study aims to create a 3D digital model of a patient-specific lumbar vertebra that can be used for planning, surgical navigation, and training of the SDR operation. The 3D printing model is also manufactured for more effective work during these processes.
Traditional orthopedic digital models rely almost entirely on computed tomography (CT) data, which is less sensitive to soft tissues. Fusion of the bone structure from CT and the neural structure from magnetic resonance imaging (MRI) is the key element for the model reconstruction in this study. The patient&#39;s specific 3D digital model is reconstructed for the real appearance of the surgical area and shows the accurate measurement of inter-structural distances and regional segmentation, which can effectively help in the preoperative planning and training of SDR. The transparent bone structure material of the 3D-printed model allows surgeons to clearly distinguish the relative relationship between the spinal nerve and the vertebral plate of the operated segment, enhancing their anatomical understanding and spatial sense of the structure. The advantages of the individualized 3D digital model and its accurate relationship between spinal nerve and bone structures make this method a good choice for preoperative planning of SDR surgery.

This study aims to create a 3D-printed model of a patient-specific lumbar vertebra, which contains both the vertebra and spinal nerve models fused from high-resolution computed tomography (HRCT) and MRI-Dixon data.

患者特定腰椎的3D打印模型

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical ...

Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

显微镜辅助微创前腰椎椎间融合术的临床应用

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for ...