Endoscope With Transpedicular Channel For The Treatment Of Thoracic And Lumbar Tuberculosis The Anatomic Observation And Clinical Feasibility Study

Objective:The dried specimens to observe and overall samples of human vertebral anatomy with the anatomy of the literature review to describe the shape of vertebral pedicle and adjacent structures, and asked the pedicle channel endoscope with the treatment of thoracic and lumbar spinal tuberculosis surgery style feasible, and the the thoracolumbar normal imaging photo angle of the pedicle and transverse longitudinal diameter measurement studies to quantify the pedicle orientation and morphology data, then discuss its security through the simulation of surgical procedures of the human body specimens, to predict problems that may arise in the technique and propose a solution to investigate its clinical value, summed up the surgical indications and contraindications, and carried out under the endoscope with the pedicle channel approach in clinicalclear treatment indications in patients with thoracolumbar spinal tuberculosis, as the case of vertebral lesions, statistical follow-up results of operations, and hope to achieve a minimally invasive, safe, and debridement and a more thorough and take into account the advantages of fixed securely in the rear of the pedicle screw surgery feasible and there are clear prospects for the development of minimally invasive technique of pedicle screw fixation percutaneous vertebral tuberculosis.Methods:(1)5to pay a total of65adult vertebrae (T5to L5) dry specimens pedicle observation, combined with the literature description of open pedicle channel analog endoscope with the surgical approach through the pedicle channelunderstand the problems that may arise in the operation, and try the improved method, and to observe the cancellous bone within the vertebral body after the operation to clear the thoroughness.5overall specimen anatomical observation, understanding of the pedicle adjacent tissue, and confirmed the feasibility of the pedicle channel.(2) Under normal circumstances with the School of CT technology, imaging reports50cases of normal height of human thoracic and lumbar vertebral body simulation preoperative measurements, T5to L5total of13vertebral pedicle within the cutting angle, the lower inclination and crosslongitudinal diameter, further description of the pedicle channel morphology, and discuss the appropriate channel of the vertebral pedicle opening the location and operation point of view, statistical data to facilitate analog operation surgery.(3) three human specimens T5～L5, vertebral simulate the surgical approach, and observe whether there is an important organizational structure damage, summed up the problems in the safety of the surgical operation and simulation approach, and proposed the techniquerisk and remedial measures that may be encountered, and to summarize the surgical indications and contraindications.(4) in preliminary clinical application:clinical work, select six cases of T5,～L5vertebral tuberculosis are the indications for surgery were treated with pedicle screw fixation removal by endoscope with the pedicle channel approach for thoracolumbar tuberculosissurgical procedures and postoperative follow-up.Addition to the more limited part of the thoracic pedicle channel narrow unable to probe into the operating instruments and endoscopic operations or operating.Results:(1) human stem specimens observed each vertebral pedicle open pedicle channel can retain the surrounding boneoperate under the cortex of the vertebral body cancellous bone above and below the cortical bone by a pedicle channel narrow thoracic pedicle of the vertebral body cortical bone in bite except operation can operate smoothly.Normal thoracic vertebrae and ribs consisting of pedicle-rib unit to allow the composition of bone channel to solve the simple pedicle is too narrow can not read the literature of the vertebral body adjacent structures around and5vertebral body adjacent to the anatomical observation of human specimensequipment and objective procedure and pedicle adjacent soft tissue contact.(2) simulation of preoperative imaging measurements, image statistics conventional pedicle channel values, and found the same vertebral body, no significant differences in the bilateral and gender of the normal vertebrae at the base of vertical and horizontal diameter, and within Cutaway and dip(P <0.05).Vertebral body diameter side, within the longitudinal diameter sufficient inside diameter in the main discussion:T5pedicle transverse diameter of the smallest (3.5±0.2mm), down to gradually increase, T6,～T12fluctuated significantly, T8(6.5±0.4mm); lumbar aspects, L1to L5vertebral body diameter gradually increasing the L1minimum (6.5±0.5mm), L5(15.4±0.4mm).CT measurement results within Cutaway T5～T823.7°～24.4°, T9L1is25.7°～26.8°, L2～L4,27.4°～30.4°, L5was41.9.Inclination angle in the sagittal plane of each vertebral body T5,～T9angle pretext migraine tends to level, for the first partial5.6°to0°; T10to L2to the sacral side,0°～8.9°sacral partial; L3,～L5bias cephalad L5head side to reach11.7°.By CT three-dimensional positioning, we can see that the choice of pedicle channel openings similar to the conventional surgical implantation of pedicle screw openings.Measured values for the back of the human specimen simulation approach provides a data reference.That preoperative measurements through standardized images of great help to grasp the surgical indications, exclude individual differences and surgery operation.(3) Human simulation of surgical procedures, thoracic pedicle channel in addition to a small number of central stenosis operation of the pedicle channel can not probe into the pedicle clear instruments and bite in addition to part of the pedicle lateral cortex, and the rest are reserved pediclecortical bone around.After the operation, to open the lamina, observation of spinal nerve root without damage, pedicle cortex to retain the operating action and spinal nerve root "zero-touch".Summary of the discussion endoscope with the indications of the pedicle channel treatment of thoracolumbar tuberculosis and surgical contraindications, risk of surgery may be encountered and remedial measures.(4) the indications for surgery,6cases of thoracolumbar spinal tuberculosis underwent posterior endoscopy with tuberculosis of the thoracic and lumbar pedicle channel approach to clear the pedicle screw fixation, and endoscopic visualization ofthe whole vertebral body lesions cleared, endoscopic tuberculosis cleared completely, the spinal nerve root injury, postoperative patients recovered well, soft tissue injury, vertebral body shape recovery routine followed up without exception.Conclusion:The Anatomy of pedicle morphology and adjacent structures and imaging measurements of pedicle morphology in patients fully understand the proposed clinical application of endoscopic techniques with the operating instruments through both sides of the pedicle channel into the front of the vertebral tuberculosisvisual state debridement is feasible, the surgical procedure is expected to set the advantages of the endoscope and the pedicle channel, there are minimally invasive, safe, debridement thoroughly and fixed solid pedicle screw surgery practicableand the prospects for the development of minimally invasive techniques.