| Objective: Lumbar disc herniation is the most common and multiple,which is the most common cause of back and leg pain. The nucleus pulposusprotrudes from a degenerative intervertebral disc through a annulus fibrosusclefts into the spine canal or penetrates the endplate into the vertebral body,which could stimulate or constrict tissues around and cause clinical symptoms.According to the position that the nucleus pulposus may protrude from,lumbar disc herniation could be divided into three kinds, they are lateral discherniation, foraminal lumbar disc herniation, and central lumbar discherniation. Central lumbar disc herniation (CLDH),it is that the the nucleuspulposus protrude from the back central site of the annulus fibrosus. Thelateral site of the annulus fibrosus is the weak point of its structure.So it iscommon to see a lateral disc herniation. But there are still many patientssuffering from central lumbar disc herniation in hospital. Some studies haveshown that the incidence rate of central lumbar disc herniation range from5.4%to33.4%.Patients need to take surgery treatment if there is no effectivewith regular conservative treatment. The clinical manifestations of central typelumbar intervertebral disc protrusion are complex and diverse. The leg paincan be unilateral or bilateral, and some are cauda equina symptoms. Sopatients with central lumbar disc herniation often underwent unilateral orbilateral fenestration according to their clinical symptoms. And if they alsohave spinal stenosis, they should underwent full laminectomy surgery. Thetraditional open operation do a lot trauma to patients’ body, and cause muchblood lose during the operation. After surgery patients should spend a longtime on the recovery.And with the laminectomy, there is a risk of sufferingLumbar spine instability syndrome after the surgery. With the advancement of science technology and medical equipment, many minimally invasive spinetechnologies were being used in the treatment of lumbar disc herniation. Thetransforaminal endoscopic spine system TESSYS technology combinespercutaneous techniques with spinal endoscopy techniques. Its adventprovides a new solution for treating central lumbar disc herniation. Bycomparing the analysis of the indicators of this surgery and clinical symptomsimprovement, we would discuss the clinical effects of percutaneoustransforaminal endoscopic discectomy using TESSYS technology on treatingcentral lumbar disc herniation.Methods: From2011-1to2013-7，69cases of CLDH underwentpercutaneous transforaminal endoscopic surgery in our hospital.We made patients taken the prone position during the operation. Under C-arm X-ray machine anteroposterior fluoroscopy we mark of the rows ofprocessus spinosus in the midline and of operation target lumbar disc’s upperedge in the horizontal. Now with the C-arm in a position for lateral we make arow following the direction of the herniated disk, and making it through thelower vertebral body’s upper edge marked with a sterile marker on the skin.The point of intersection between the marked horizontal line and the obliquedirectional line gives the point of insertion of the needle. A safe line alsoshould be made through the facet joint’s upper edge line.If the herniated discat L5-S1segment, iliac crest the highest point of connection line should bemade under C-arm X-ray machine anteroposterior fluoroscopy. Under lateralx-ray fluoroscopy making a line that could through the S1upper facet jointand S1vertebral body’s upper edge on the skin. The point of intersectionbetween this line and the iliac crest the highest point of connection line givesthe point of insertion of the needle. An estimated lateral distance to segmentL2-3and L3-4of6-10cm is chosen. If it is the segment L4-5and L5-S1, itwould be12-14cm. After disinfecting skin routinely and blanketing steriletowels, we give patient local infiltration anesthesia with1%lidocaine. An18-gauge needle is advanced to the lateral foramen under the guidance ofC-arm X-ray machine. Making the needle meets the facet joint’s lower edge. Then take out the stylet in the18-gauge needle and put a22-gauge curvedneedle advance through the18-gauge needle. The tip of this22-gauge curvedneedle should reach the region of the herniated disk. Then injection contrastagent into the herniated disk. Take out the22-gauge curved needle, and aguide wire is advanced through the18-gauge needle, and then removed the18-gauge needle. Make a stab incision approximately8mm long on the skin.Then use the straight guide rods in increasing sizes to advance to the facetjoint to widen the soft-tissue channel. With the guide rods removed, reamers inincreasing sizes are inserted into the soft-tissue channel. Now we can usereamer to remove part of the facet joint, and then the neuroforamen is widened.The reaming procedure should be controlled radiologically in two planes.After removal of the last reamer used, the working cannula and the endoscopeare advanced to the herniated disk. We introduce a grasping forceps throughthe endoscope and remove the herniated disk. A pulsation of the nerve rootshould be visible and straight leg raising test should be negative after thedecompression. At last using radio frequency bipolar electrodes to shrink theannular gap and stanch bleeding. The working cannula and endoscope areremoved and the stab incision closed.69cases of CLDH with average age of37.5years (range form17to83years). In these69cases，34were males and35were females. The visualanalogue scale(VAS)，Japanese Orthopaedic Association (JOA) Scores wereemployed to measure the clinical outcome.Results: The operation successful in67cases of all69cases.67caseswere followed up3-18months (average11.6months). The mean VAS of the67cases were improved from (7.12±0.70) before the operation to (2.27±0.74)one year after the operation. The JOA scores increased from (13.7±0.87) to(22.1±0.79) one year after the operation. There were no intervertebralinfection, dural matter tear or neurovascular injure due to the operation. Onepatient had no significant relief after operation, and two patients changed touse microendoscopic to do the surgery during the operation. There were threerecurrent cases had been underwent Posterior Lumbar Interbody Fusion revision surgery. Excellent and good outcomes were obtained in83.5%of allcases.Conclusion:Transforaminal endoscopic spine system (TESSYS) per-cutaneous transforaminal endoscopic technique is safe and efficacious intreating CLDH. Complying with the surgical indications is the key to achievegood results. |
PDF Full Text Request