| Objective:Anatomize the intervertebral foramen of L3/4,L4/5, L5/S1 and the structure around them of the adult bodies.Measure the anatomical data about the Full-Endoscopic transforaminal extreme lateral approach,to clarify the relationship of intervertebral foramen,nerve root and the important structure around them.To evaluate the valuation of Full-Endoscopic transforaminal extreme lateral approach for the surgical treatment of Lumbar Disc Herniation.Methods:Get the following data with the vernier caliper and the protractor:diameter of the nerve root of L3/4,L4/5,L5/S1.Superior foraminal width,minimum foraminal width,pedicle length,foraminal height,distance from lower border of the nerve root to lower border of the foramen,area of the safety triangle.Prospective study of patients with lumbar disc herniations who were operated on with a full-endoscopic uniportal transforaminal approach using an extreme lateral access in our hospital from August to October,2008.Both of them are adolescence, female,single segment disease in L4/5,the average course of disease are 4.5 months.Both are combined with serious leg pain,the clinical symptoms,signs and imaging information coincide.Study parameters included operative time,blood loss,complications and efficacy,and analysis of all patients with preoperative and postoperative 3 months and at the time of last follow-up Oswestry low back pain and leg pain VAS.Result:Anatomical study:the area of foramen intervertebrale:L 3/4 left side 119.3±24.9 mm~2,right side 124.6±29.7 mm~2;L4/5 l eft side 168.4±27.3mm~2,right side 177.6±30.1 mm~2;the mai-n a natomical structure of Full-Endoscopic transforaminal extreme la-tera l approach is the safety triangle.The safety triangle area in L3/4 le ft side 72.8±6.3 mm~2,right side 74.9±7.2 mm~2;L4/5 left side 91. 2±7.6mm~2,right side 94.5±8.1 mm~2.The superior articul-ar proces s is the sign of the Full-Endoscopic transforaminal extre-me lateral approach.At level L5/S1 and often above,the necessar-y lateral ac cess is usually not possible due to the iliac crest.Clinical study:The mean operating time is 50min,no measureab -le blood loss occurred.Incision length is 0.5cm,and the distance f -rom the incision to the linea mediana posterior is 13cm.There w -ere no surgery related complications in any patient.Mobilization is possible without exception the second day after operation.The av -erage hospital stays is seven days.Both of them no pain and lasegue sign is negative when leave hospital.Results After 6 months of follow-up,the pain was reduced or disappear,no effect on their work and life.The following measuring instruments were used:Visual Analogue Scale,Oswestry low back pain disability questionnair -e.Results:there are significant difference(P＜0.05) between third m onths postoperation and preoperation,no significant difference(P＞0.0 5)between the last follow-up and the third months postoperation.Conclusion:Full-endoscopic uniportal transforaminal approach ha -s advantage of shorter operating time,smaller incision and more ra -pid recovery,the recent results are satisfactory.The long-term resul -ts are not sure because of the limited time for the start of this op -eration and this clinical study.It need a follow-up for a longer tim -e. |
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