Name: a suture technique for ruptured annulus fibrosus following decompression under percutaneous transforaminal endoscopic discectomy
Uploaded: 2024-01-26T13:45:00.000+00:00
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Description: Watch this Scientific Journal Video about Author Spotlight: Development and Application of a Novel Suture Technique for Annular Fibrosus Repair in Percutaneous Transforaminal Endoscopic Discectomy at

这项工作得到了南山区卫生科技项目（批准号）NS2023002;NS2023044）、广东省医学科学研究基金（批准号:A2023195）、南山区卫生科技重大专项（批准号:）、广东省医学科学研究基金（批准号:号）、南山区卫生科技重大专项（批准号:号）、南山区卫生科技重大专项（批准号:NSZD2023023;NSZD2023026）、国家自然科学基金（批准号:82102640）和国家重点研发计划（批准号:2022YFC3602203）。

该协议遵守华中科技大学联合深圳医院伦理委员会制定的规定，该委员会已批准该协议。已获得患者的书面知情同意书。入组一名 31 岁的女性患者，她患有持续的左腿放射痛，视觉模拟量表 （VAS）7 等于 8。体格检查结果如下:（1）上半身右侧弯曲;（2）前倾和后倾的运动范围受限;（3）左直腿抬高试验和Braggard试验阳性;（4）左胫骨前力量4级;（5）左小腿外侧和左脚背侧麻木。MRI 证实腰椎 4-5 椎间盘突出症（左旁正中型）呈阳性。她接受过无效的门诊保守治疗，包括休息、非甾体抗炎药（塞来昔布 200 mg/天，持续 6 周）和针灸两个月。研究中使用的手术工具和设备列在 材料表中。
1.内窥镜下减压
<ol><li>体位和麻醉<ol><li>通过经椎间孔入路进行内窥镜腰椎间盘切除术8.将患者置于俯卧位，并在透视引导下标记皮肤穿刺点。局部消毒和悬垂后，将 0.5% 利多卡因 （10 mL） 注射到穿刺点。</li>
	</ol></li>
	<li>穿刺和套管放置<ol><li>使用 18 G 针在标记的穿刺点进行穿刺，并在透视下调整位置。逐步插入扩张套管（直径 3.7 毫米）并在透视下确认达到理想位置。</li>
	</ol></li>
	<li>内镜下腰椎减压术<ol><li>插入不同尺寸（直径 5 毫米、8 毫米和 10 毫米）的环钻锯并旋转以去除 L5 上关节突的颅、背和尾侧的骨头，以进行椎间孔成形术9。</li>
		<li>逐步暴露并去除软组织。观察椎间盘突出的疑似区域（丘陵状，通常与周围的平坦区域明显不同）。确定目标椎间盘突出和受压神经根10.</li>
		<li>识别并切除突出和松动的椎间盘（包括 AF、NP 和软骨终板）。检查减压的神经根，确认不存在残余椎间盘。 注意:为了确定目标突出，我们的经验是评估椎间盘材料的颜色、质地和形状。与周围的正常组织相比，破裂或突出的椎间盘可能会出现变色、碎裂或移位。为了检查减压神经根的状况，让患者咳嗽并观察减压神经根的"脉动"状态11。</li>
	</ol></li>
</ol>2. PLL-AF缝合技术
<ol><li>外侧 AF 撕裂的穿透<ol><li>使用一次性环形吻合器进行内窥镜缝合12.识别AF撕裂，并使用环形吻合器中的曲线形针头将第一针（丝制成，直径0.4 mm）穿透完整的横向AF组织（图1A）。检查并确认针脚已牢固固定（图 1B）。</li>
	</ol></li>
	<li>锁相环（PLL）缝合<ol><li>将第二针（丝质，直径 0.4 毫米）穿入 PLL 中，并确认它也穿透下方完整的内侧 AF。检查并确认针脚已牢固固定。然后，用方结拧紧第一针和第二针（图1C）。 注意:在减压后识别 PLL 有时可能具有挑战性。建议仔细操作并确定椎管的内侧和背侧区域。</li>
	</ol></li>
	<li>三、加强针脚<ol><li>在完整AF的侧面区域和第二针的颅骨位置（图1E）剪切第一针（图1D）并穿透第三针（丝绸制成，直径0.4毫米）。</li>
		<li>检查并确认针脚已牢固固定。打一个方结后剪断两针（图1F）。再次检查神经根，确保不存在压迫。</li>
	</ol></li>
</ol>3.术后管理
<ol><li>静脉注射 50 mg 氟比洛芬 axetil 治疗术后疼痛。</li>
	<li>手术后，在没有出现特殊情况或并发症的情况下，允许患者在术后一天离开床，并提供腰部支架13 （半刚性类型，带有金属或塑料支柱作为支撑）。</li>
</ol>

用于腰椎内窥镜纤维环修复的新型 PLL-AF 缝合技术

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本研究的作者声明不存在利益冲突。

在内窥镜下实现出色的 AF 缝合具有显着的好处。预计它可以减少由 AF 破裂或隆起引起的神经机械刺激，从而减少术后残留的椎间盘源性腰痛和/或坐骨神经痛 4,12。关闭环状泪门可以减少由椎间盘释放炎症介质引起的神经根刺激5.此外，患者可以在手术后早期更有信心地活动。这种信心有助于加速恢复过程，并在恢复力量和功能方面取得更好的结果14.
本研究首次引入了一种新型的AF缝合技术，该技术首次使用PLL作为缝合材料，提供了一种新方法来解决传统单针缝合方法导致的张力不足以及减压后撕裂周围缺乏健康或坚固的AF组织。此外，PLL 紧紧缝合在 AF 撕裂上方，从而增加了压缩段处的腰椎管体积。在内窥镜引导下进行第二次缝合时，确保 PLL 和健康的 AF 同时穿透泪液内侧部分，同时避免与神经根接触，这一点至关重要。
在文献中，很少有研究报道 PETD 4,6,15 的 AF 缝合技术。大多数研究集中在腰椎显微内窥镜椎间盘切除术 （MED） 或开放性椎间盘切除术后的 AF 缝合。根据最近一项荟萃分析，该分析检查了 7 项随机对照研究和 8 项观察性研究，发现椎间盘切除术联合 AF 缝合可以有效降低 LDH16 患者的术后复发率和再次手术率。Li et al.12 发现，已经研究了 AF 缝合线和自体条件血浆椎间盘内注射的组合，表明与不缝合的病例相比，可有效降低 LDH 的复发率 4%。另一项研究比较了 PETD 与 MED 在减压后进行 AF 缝合的临床结果，报告称 MED 技术表现出更好的椎间盘高度保留，并在降低复发率方面显示出优势，尽管两种技术之间没有观察到统计学差异17.
这种技术有两个局限性。实现这种技术的一个先决条件是外科医生必须具有丰富的内窥镜手术经验。因此，与该技术的发展相关的有一定的学习曲线。其次，这项研究是一份技术报告。这种缝合技术的长期有效性应在更大的样本群体中进行检查。第三，该技术并不适用于所有LDH病例。例如，如果 AF 撕裂在减压后变得太窄，可能不需要缝合。

经皮经椎间孔内窥镜椎间盘切除术 （PETD） 是一种用于切除腰椎椎间盘突出的微创手术，使用内窥镜进行 - 内窥镜是一根细管，尖端带有摄像头和灯，使外科医生能够在监视器上观察内部组织和周围结构1。通过监视器上的实时图像引导，外科医生可以通过大约 1 厘米的小皮肤切口进行套管2 的定位、穿刺和放置。接下来在内窥镜下逐步暴露，包括切除周围的软组织和椎间孔成形术以扩大目标腰椎孔的开口。一旦获得清晰的视野和足够的手术空间，就通过移除受压碎片3 对腰神经进行完全减压。
预防椎间盘突出症术后复发仍然是脊柱外科医生长期关注的问题。在手术过程中，将复发风险降至最低的一种策略是切除所有疑似分离的髓核 （NP），即使它尚未疝入耳道。这是因为破裂的纤维环 （AF） 无法完全修复，因此，易受椎间盘内压力影响的脱落 NP 组织将来可能会再疝4。
尽管在修复和再生髓核 （NP） 和纤维环 （AF） 的组织工程方面取得了可喜的进展，但它们都没有被临床证明有效5.完全减压后直接闭合心房颤动撕裂是降低腰椎间盘突出症 （LDH） 复发风险的重要技术。目前，在内窥镜检查下，最常用的 AF 修复缝合技术是在泪液部位进行简单的缝合，只需缝一针6。除了担心单针是否能产生足够的张力外，内窥镜减压后，经常会遇到环状撕裂两侧缝合面积不足（无论是质量还是数量）不足的情况。
因此，本研究提出了一种在PETD减压后缝合AF的新技术，方法是将附近的后纵韧带（PLL）拉动并缝合在AF撕裂上，并缝合三针（PLL-AF缝合技术）。

<table><tbody><tr><td>0.5% lidocaine&amp;nbsp;</td><td>Beijing Tide Pharmaceutical Co., Ltd</td><td>H37022768</td><td>For postoperative pain</td></tr><tr><td>Dilatation cannula</td><td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td><td>ZJ289019</td><td>Cannulation</td></tr><tr><td>Disposable annular stapler&amp;nbsp;</td><td>Medical Science &amp;amp; Technology Co., Ltd., Beijing</td><td>SMILE-L, 2020</td><td>Suture</td></tr><tr><td>Disposable stitches</td><td>Medical Science &amp;amp; Technology Co., Ltd., Beijing</td><td>SMILE-L, 2020-022</td><td>Stitch</td></tr><tr><td>Flurbiprofen axetil&amp;nbsp;</td><td>Shandong Hualu Pharmaceutical Co., Ltd.</td><td>H20041508</td><td>For postoperative pain</td></tr><tr><td>Puncture needle</td><td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td><td>ZJ289033</td><td>Puncture</td></tr><tr><td>Trephine saws&amp;nbsp;</td><td>Beijing Tianqi Medical technology Co., Ltd., Beijing</td><td>ZJ289036</td><td>Foraminoplasty</td></tr></tbody></table>

a suture technique for ruptured annulus fibrosus following decompression under percutaneous transforaminal endoscopic discectomy

全内窥镜检查下纤维环破裂 （AF） 的缝合技术仍然具有挑战性。在完全减压后直接缝合破裂的环状撕裂已被证明可以降低内窥镜手术期间腰椎间盘突出症的复发率。内窥镜检查下的传统缝合手术仅涉及对破裂的 AF 进行简单缝合。由于泪门周围的 AF 组织薄弱且质量差，因此在缝合过程中将该区域用作针插入点可能会导致张力不足和 AF 闭合成功率低。目前，尚无基于视频的腰椎全内镜下AF撕裂缝合的详细技术说明。我们创新性地提出了一种覆盖和缝合AF撕裂的方法，即在腰椎内镜检查下拉起后纵韧带（PLL），并使用三针（PLL-AF缝合技术）。接受新型缝合技术的患者取得了令人满意的效果。手术6个月后，腰椎MRI在门诊未显示复发迹象。

在成功和充分的减压后，切除了L4/5处的突出椎间盘（图2A，A'）。在内窥镜下识别出局部 AF 撕裂（内侧和外侧撕裂边缘）和 PLL。第一次缝合确保外侧撕裂边缘得到控制和缝合。PLL 和内侧 AF 撕裂边缘与第一针一起被穿透并缝合。将第三针与第二针在第一针的颅侧绑在一起。该技术的关键点是穿透 PLL 和内侧完整 AF 并拉动以覆盖和缝合外侧 AF 撕裂。
患者的人口统计学信息、临床资料、手术结果和随访资料如 表1所示。总操作时间为 83 分钟。手术后一天，患者被允许带着腰部支具离开床。腿痛术后 VAS7 降至 1 分。术后MRI显示左L4/5神经根成功减压（图2B，B'）。下肢和足部麻木感明显下降，出院当天左胫骨前力量提高至4+级。在六个月的随访中，进行了腰椎MRI，未观察到复发的证据（图2C，C'）。患者报告左下肢没有放射痛或麻木。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65886/65886fig01.jpg"> 图 1:内窥镜下新型 3 针纤维环 （AF） 缝合技术示意图。 （A） 减压后目标水平的局部结构（PLL 表示后纵韧带）。（B） 在自动对焦的侧面部分穿透第一针。（C） 第二针穿透 PLL 并用第一针收紧以打一个方结。（D） 剪掉第一针，但保留第二针。（E） 在AF的外侧部分和第二针的颅骨位置穿透第三针。（F） 打结后剪切两针。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65886/65886fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65886/65886fig02.jpg"> 图 2:使用 PLL-AF 缝合技术在 PETD 下对患者进行术前和随访腰椎 MRI。 （A） 和 （A'） 表示术前矢状和轴向 MRI，显示 L4/5 突出伴左神经根受压。（B）和（B'）表示术后MRI检查，神经根减压。（C） 和 （C'） 表示六个月随访时的腰椎 MRI。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/65886/65886fig02large.jpg" target="_blank">请点击这里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>参数</td>
			<td>值</td>
		</tr><tr><td>年龄（岁）</td>
			<td>31</td>
		</tr><tr><td>性</td>
			<td>女性</td>
		</tr><tr><td>体重指数#</td>
			<td>25.3</td>
		</tr><tr><td>疝气部位</td>
			<td>L4/5级</td>
		</tr><tr><td>疝气类型</td>
			<td>左副中位型</td>
		</tr><tr><td>操作时间（分钟）</td>
			<td>83</td>
		</tr><tr><td>术前 VAS*</td>
			<td>8</td>
		</tr><tr><td>术后VAS</td>
			<td>1</td>
		</tr><tr><td>6m 随访时的 VAS</td>
			<td>0</td>
		</tr><tr><td>#BMI:体重指数; *VAS:视觉模拟量表。</td>
			<td></td>
		</tr></tbody></table>表 1:入组患者的人口统计学信息、临床数据、手术结果和随访数据摘要。

Watch this Scientific Journal Video about Author Spotlight: Development and Application of a Novel Suture Technique for Annular Fibrosus Repair in Percutaneous Transforaminal Endoscopic Discectomy at 

作者聚焦: 经皮经椎间孔内窥镜椎间盘切除术中用于环状纤维肌瘤修复的新型缝合技术的开发和应用

该方案描述了一种创新的缝合技术，用于在经皮经椎间孔内窥镜椎间盘切除术中破裂的环状纤维。

经皮经椎间孔内窥镜椎间盘切除术减压后纤维环破裂的缝合技术

The suture technique for a ruptured annulus fibrosus (AF) under full-endoscopy remains challenging. Direct suturing of a ruptured annular tear after full ...

本研究描述了一种创新的缝合技术，用于经皮经椎间孔内窥镜椎间盘切除术中环状纤维破裂，我们提出了一种通过拉起腰椎下后纵韧带进行内窥镜检查来缝合环状纤维撕裂的方法。要进行腰椎疝症的内窥镜手术技术，外科医生必须具备丰富的经验。然而，并非每个腰椎疝患者都适合采用这种技术。在某些情况下，如果环状撕裂在减压后变得太窄，则可能不需要缝合。该技术提供了一种新的解决方案，可以解决由于传统的单碟缝合方法在腰椎内窥镜减压后出现的张力不足的问题。此外，环状纤维化撕裂周围的后纵韧带紧密可见，这有助于增加受压段处的腰椎管体积。

a-suture-technique-for-ruptured-annulus-fibrosus-following

Universidad San Sebastian

Research

JoVE Journal

Medicine

A Suture Technique for Ruptured Annulus Fibrosus Following Decompression Under Percutaneous Transforaminal Endoscopic Discectomy

680 次观看.  Huazhong University of Science and Technology Union Shenzhen Hospital. 本研究描述了一种创新的缝合技术，用于经皮经椎间孔内窥镜椎间盘切除术中环状纤维破裂，我们提出了一种通过拉起腰椎下后纵韧带进行内窥镜检查来缝合环状纤维撕裂的方法。要进行腰椎疝症的内窥镜手术技术，外科医生必须具备丰富的经验。然而，并非每个腰椎疝患者都适合采用这种技术。在某些情况下，如果环状撕裂在减压后变得太窄，则可能不需要缝合。该?...

视频: 作者聚焦: 经皮经椎间孔内窥镜椎间盘切除术中用于环状纤维肌瘤修复的新型缝合技术的开发和应用

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. ...

科研

医学

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

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

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

Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation

We report a novel technique for C-arm free transtubular L5 nerve decompression under CT-based navigation to reduce the radiation hazard. This procedure is performed under general anesthesia and neuromonitoring. The patient is placed in a prone position on an operating carbon table. A navigation reference frame is placed percutaneously into the contralateral sacroiliac joint or spinous process. Then, CT scan images are obtained. After instrument registration, the L5-S1 foraminal level is confirmed with a navigated probe, and the entry point is marked. Using an approximately 2 cm skin incision, the subcutaneous tissue and muscles are dissected. The navigated first dilator is aimed at the L5-S1 Kambin&#39;s triangle, and sequential dilation is performed. The 18 mm tube is used and fixed to the frame. The bone around the Kambin&#39;s triangle is removed with a navigated burr. For lateral disc herniation, the L5 nerve root is identified and retracted, and the disc fragment is removed. The navigation-guided tubular endoscopic decompression is an effective procedure. There is no radiation hazard to the surgeon or the operating room staff.

Presented here is a novel technique of C-arm free transtubular posterolateral decompression for lumbar foraminal stenosis and lateral disc herniation under O-arm navigation.

经管内镜后外侧减压治疗L5-S1腰椎外侧椎间盘突出症

We report a novel technique for C-arm free transtubular L5 nerve decompression under CT-based navigation to reduce the radiation hazard. This procedure is ...

神经科学

Full-Endoscopic Transforaminal Approach for Lumbar Discectomy

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.

<meta charset="utf8"></head><body>全内窥镜经椎间孔入路治疗腰椎间盘切除术

The present protocol describes the full-endoscopic transforaminal approach for lumbar discectomy, which is a safe technique that does not require muscle retraction or bone removal.

全内窥镜经椎间孔入路治疗腰椎间盘切除术

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes ...

Full Endoscopic Transforaminal Thoracic Discectomy Operative Technique

Thoracic disc herniations are a degenerative pathology of the thoracic spine wherein a portion of nucleus pulposis herniates into the epidural space, potentially causing spinal cord or nerve root compression. Traditional surgical treatment for patients with thoracic disc herniations requires relatively invasive anterior or posterolateral approaches that involve extensive muscular dissection and removal of bone in order to access and remove the disc herniation without causing undue compression of the spinal cord. Full endoscopic thoracic discectomy is a minimally invasive technique which allows for the resection of thoracic disc herniations through a small (1 cm) incision, minimizing collateral tissue trauma and obviating the need for the extensive muscle dissection and bony removal required for traditional surgical approaches. In this article, we describe in detail the operative technique for full endoscopic thoracic discectomy and discuss the pearls and pitfalls of the technique. We also provide a review of the outcomes and complications as seen in the literature.

<meta charset="utf8"></head><body>全内窥镜经椎间孔胸椎间盘切除术手术技术

This protocol demonstrates the surgical technique for full endoscopic transforaminal resection of thoracic disc herniations.

全内窥镜经椎间孔胸椎间盘切除术手术技术

Thoracic disc herniations are a degenerative pathology of the thoracic spine wherein a portion of nucleus pulposis herniates into the epidural space, ...

Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming more common. Full-endoscopic spinal surgeries have the advantages of being less invasive and offering a shorter recovery time. Here, we describe the technique of the full-endoscopic interlaminar approach for the decompression of lateral recess stenosis. The full-endoscopic interlaminar approach for the lateral recess stenosis procedure took approximately 51 min (range of 39-66 min). Blood loss could not be measured due to continuous irrigation. However, no drainage was required. There were no dura mater injuries reported in our institution. Furthermore, there were no injuries to the nerves, no cauda equine syndrome, and no hematoma formation. The patients were mobilized on the same day as surgery and discharged the next day. Therefore, the full-endoscopic technique for lateral recess stenosis decompression is a feasible procedure that lowers the operational time, complications, traumatization, and rehabilitation duration.

<meta charset="utf8"></head><body>全内窥镜椎板间入路减压外侧隐窝狭窄

Technical advances and increased experience in full-endoscopic spinal surgeries enable these procedures to be performed with minimal incision, muscle retraction, and bone removal.

全内窥镜椎板间入路减压外侧隐窝狭窄

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming ...

Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation

The full endoscopic interlaminar approach (FEILA) is a minimally invasive technique for lumbar discectomy. It has multiple advantages over other conventional discectomy methods, including less traumatization of the soft tissues, fewer complication rates (dural injury, bleeding), rapid rehabilitation, quick return to daily life activities, and preferable cosmetic results. FEILA is a surgery with a relatively steep learning adaptation. Endoscopic surgery is a closed tubular approach, and all surgical maneuvers are performed within a uniportal single working channel. Also, the technique has not yet been standardized and well-documented. Therefore, the early learning stages of this technique may not be easy for most surgeons. Despite these, FEILA is easy, and the operation length is comparable to and even shorter than other techniques of lumbar discectomy. FEILA for lumbar discectomy could be considered a safe and effective alternative procedure for paracentral L5-S1 disc herniation. Here, we describe the technique of FEILA, including every cutoff step required to reach technical proficiency for surgeons who want to start applying this approach.

<meta charset="utf8"></head><body>全内窥镜椎板间入路治疗中央旁 L5-S1 椎间盘突出症

Here, we present a protocol to describe the full endoscopic interlaminar approach (FEILA) technique, including every cutoff step required to reach technical proficiency. FEILA is a surgery with a relatively steep learning adaptation. Despite this, any surgeon capable of microdiscectomy can perform FEILA with enough practice and suitable patient selection.

经皮经椎间孔内窥镜椎间盘切除术减压后纤维环破裂的缝合技术

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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

腰椎间盘椎间盘经神经孔腰椎内窥镜的移动外技术

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