Name: treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation
Uploaded: 2018-06-26T12:30:00.000+00:00
Duration: 4 min 42 s
Description: Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

作者感谢加布里埃尔. 莱顿修改了本文件的最后草稿。

1. 患者选择
<ol><li>对 FBSS20进行诊断。</li>
	<li>
确保 FBSS 病人符合所有纳入标准, 然后接受 SCS 试验:
	<ol>
<li>慢性腰痛和/或根腿疼痛, 最理想的医疗治疗至少6月。</li>
		<li>持续性疼痛, 尽管3种药物治疗 (扑热息痛, 非甾体抗炎药物, 阿片类药物, 抗惊厥药物等)。</li>
		<li>Lemniscal 通路必须保持至少部分完好 (为麻木覆盖痛苦的区域)。</li>
	</ol>
</li>
	<li>排除 FBSS 患者中 SCS 的排除标准, 如主动感染、药物成瘾或持续戒断、心理禁忌症、低血压的机械原因 (腰痛疼痛、腰椎滑脱、脊柱不稳定和后关节骨关节炎) 和凝血障碍 (由于出血和硬膜外血肿的风险)。通过询问相关问题, 检查病人, 并在必要时检查凝血障碍的相关血液检查, 确保不存在凝血障碍。</li>
</ol>2. 调节专家
<ol><li>如果 FBSS 病人符合公务员事务局的标准, 请向调节专家 (NMS) 咨询。 注意: 我们队的调节专家是一名护士。他完全致力于疼痛和调节, 是 pluridisciplinary 团队的协调员, 其中包括一名心理学家、理疗师和一个专科疼痛护士。</li>
	<li>描述病人疼痛通路的解剖, 解释伤害与神经病理性疼痛的区别。解释不同镇痛和镇痛药物的作用部位。 注意: 重要的是, 病人了解神经性疼痛的性质, 并能区分它与伤害疼痛。一旦病人了解了他们的神经性疼痛的生理学, 他们就准备学习 SCS。</li>
	<li>向病人解释 SCS 的理论概念。这项技术被认为是通过刺激脊髓内大直径传入神经纤维, 根据疼痛门控制理论来抑制慢性疼痛。</li>
	<li>测量的视觉模拟秤 (输精管) 评分21的腿和背部疼痛。</li>
	<li>
解释治疗的目的:
	<ol>
<li>麻木覆盖面的痛苦的区域50到70%。</li>
		<li>减轻疼痛 (输精管评分)。</li>
		<li>减少镇痛和共镇痛药物。</li>
		<li>改善睡眠质量。</li>
		<li>改善生活质量。</li>
		<li>在距离的改善走了。</li>
	</ol>
</li>
	<li>解释 SCS 设备的不同组件 (硬膜外引线、内部脉冲发生器和连接引线到 IPG 的延长线), 让病人操纵他们更好地了解系统。</li>
</ol>3. NMS 建立健康保险档案
<ol><li>在这个文件中描述病人的疼痛特点, 生活质量, 睡眠质量, 还有病人的活动, 步行距离, 镇痛和共镇痛的消费。 注: 根据比利时法律, 精神病学评估是强制性的, 在任何手术前植入异物。精神病学家必须排除任何精神紊乱, 并评估病人的功能能力, 以便能够接受和生活在一个异物。</li>
	<li>将病人的病历和精神评估附在健康保险档案中。</li>
</ol>4. 几列铅的植入
<ol><li>在解释手术过程细节后, 包括并发症 (感染 3–6%; 严重的神经系统并发症 0.54–1.71%; 硬膜外血肿 0.19–0.63%; 脊髓损伤 0.022–0.067%;脑脊液漏 0.05–0.001%)22。 注: 比利时所需的长期试验期被认为是本机构观察到的高感染率 (11%) 的主要原因, 我们目前正在努力解决这一问题。这必须向病人解释。</li>
	<li>除上述风险外, 类似于与其他脊柱程序相关的危险, 解释通常与使用植入物有关的其他风险, 例如对植入材料的过敏或免疫系统反应;通过皮肤或迁移而导致、延伸或神经刺激器侵蚀;在硬膜外空间的铅周围形成活性组织, 可能导致脊髓压迫和瘫痪, 需要手术治疗。发病时间可以从几周到许多年后植入。 注: 经皮背柱刺激术后神经并发症发生率略高 (感染 3–6%; 严重神经并发症 0–2.35%; 硬膜外血肿 0.75%; 脊髓损伤 0.03–2.35%; 脑脊液渗漏 0.3%)22。</li>
	<li>如果病人没有任何禁忌症, 进行 MRI 排除任何异常的圆锥脊髓投射, 如脊柱闭合不全或其他先天性脊髓异常23。</li>
	<li>在切口前使用单静脉注射 (IV) 剂量的头孢唑啉, 50 毫克/千克, 最多2个 gm, 通过在外围路线放置16克针进行抗生素预防30分钟。</li>
	<li>病人全身麻醉 (使用0.1 µg/千克 Sunfentanil, 2 毫克/千克 Propolipid 1%, 0.3 毫克/千克氯胺酮 (见材料表) 和0.3 毫克/千克罗库溴铵) 和在俯卧位, 定义切口之间的棘突在透视协助下 T10 和 T11 的进程。</li>
	<li>渗透切口部位与5毫升20毫升溶液0.5% 布比卡因和1:200,000 肾上腺素 (见材料表)。</li>
	<li>切开直到胸 aponeuroses 显露。</li>
	<li>解剖旁肌组织两侧的 T10's 冈过程, 并放置牵引器。</li>
	<li>切除冈和棘间韧带, 解剖 T10 的叶片 (每一侧5毫米, craniocaudal 方向为5毫米)。</li>
	<li>在插入铅之前, 执行 T10 的部分椎板切除, 以创造足够的空间, 以允许插入铅 (不需要删除整个叶片)。</li>
	<li>将幻铅插入硬膜外腔, 同时保持 T11 叶片上部的黄韧带的插入完好。 注: 此 T11 叶片用于引导插入到硬膜外的空间。</li>
	<li>在透视指导下, 将潜在顾客尽可能内侧。在透视控制下的 T8–T9 体的投影中放置中线时, 最终引线的位置到达。</li>
	<li>通过做一个单一的打断缝合, 固定棘间韧带的 T11。</li>
	<li>通过使用公司提供的隧道工具, 将您的操作字段的扩展隧道到后面的侧面 (通常是正确的), 然后将它们连接到潜在顾客。</li>
	<li>检查 fluoroscopically, 以确保铅没有移动, 仍然在硬膜外空间, 中线, 在 T8–T9 的投射。</li>
	<li>取出牵引器, 确保没有出血。</li>
	<li>用编织合成可吸收缝合材料的简单打断缝线缝合肌-腱膜性层 (见材料表)。</li>
	<li>将两个内部外部扩展连接到两个外部扩展。隧道他们在皮下脂肪用这样方式他们通过皮肤 15 cm 侧向切口地点出口。 注意: 在手术前与病人讨论侧的选择, 取决于内部脉冲发生器的植入位置。</li>
	<li>用编织合成可吸收缝合材料 (见材料表) 的简单中断缝线包裹本征和外伸并缝合皮下层。</li>
	<li>用较细的可吸收3/0 缝合材料做 dermic subcuticular 缝合 (见材料表), 并应用防腐剂和绷带。在这一步骤中, 管理单 IV 剂量的1g 扑热息痛和100毫克 Tradonal。</li>
</ol>5. 术后试验
<ol><li>放置引线后, 将其连接到外部刺激器, 为期四周。 注意: 这个长的测试期间是比利时法律要求的条件, 以补偿在第二次手术中的脉冲发生器的植入。</li>
	<li>手术后几个小时开始编程。治疗的目的是通过愉快的麻木覆盖痛苦的区域。</li>
	<li>将外部神经刺激器连接到外部引线扩展。</li>
	<li>将临床医生程序员放在外部神经刺激器。打开临床医生程序员, 然后打开神经刺激。首先将脉冲宽度 (密码) 设置为260µs, 速度为60赫兹。</li>
	<li>如果 LP 是双边的, 执行第一次筛选使用保护阴极 (++), 从左上 tripolar 纵向刺激配置 (图 1), 以确定铅的偏侧 (右/左)。</li>
	<li>用四剩余的左侧 tripolar 纵向刺激配置 (图 2) 对左侧进行快速扫描。在这种单边筛查过程中, 确定了疼痛 metameric 水平的概念。此后, 按照相同的方案扫描右侧 (图 3)。</li>
	<li>最后, 激活刺激配置, 允许更好地麻木覆盖痛苦的腿部区域。 注: 如果存在双边 LP, 则必须对两种不同的刺激配置进行编程, 以获得对两个痛苦区域的最佳麻木覆盖率。</li>
	<li>对于背部疼痛, 使用防护的阴极配置 (图 4), 首先测试引线顶部的横向 tripolar 配置。如果此配置提供的麻木覆盖率不足, 则在阴极周围测试一个 "半花型" 配置四阳极 (图 4)。如果此配置没有提供足够的麻木覆盖和/或痛苦抑制再次, 使用 tripolar 纵向配置, 以验证可能的双边刺激由一个通道 (图 4)。</li>
	<li>微调背部疼痛区域覆盖通过增加密码450µs。这使得扩大刺激范围成为可能。调整40和60赫兹之间的脉冲速率, 以获得最满意的麻木覆盖的痛苦区域。 注: 这些设置是根据经验与这个多列手术铅, 当然可能会因不同的设备或刺激策略 (例如高强度刺激)。有关详细说明, 请参阅程序员快速指南24。</li>
	<li>确保在试验阶段 (比利时1月) 对患者进行密切随访 (至少一周一次), 通过重复步骤5.7、5.8 和 5.9, 检查适当的伤口愈合情况并优化麻木覆盖率。使用无菌技术绷带改变22。教育病人有关新出现的手术部位感染的体征和症状。</li>
	<li>在试用期结束时, 使用锋利的剪刀削减外部伸展与皮肤, 以减少感染的风险, 直到下一个手术程序。</li>
</ol>6. 内部脉冲发生器的植入
<ol><li>如果在一个月的试用期结束时疼痛缓解率高于 50% (比利时报销标准), 获得病人的知情同意, 并设置 IPG 安置日期。疼痛缓解的评估使用输精管刻度22。 注: 在不同地点的优缺点与 NMS 进行讨论后, 患者决定 IPG 安置地点。</li>
	<li>在切口前30分钟使用单静脉剂量的头孢唑啉50毫克/千克, 最多2克, 用16克针进行抗生素预防。</li>
	<li>病人在全身麻醉下 (与步骤4.3 中提到的相同的协议), 做一个7厘米长和2厘米深的切口, 并创建一个口袋里的 IPG 在腹壁脂肪或臀部的外部象限, 根据患者的愿望 (如手术前所述-步骤 6.1)。</li>
	<li>将用于铅植入的背疤 (步骤 4.3), 从周围组织中解剖铅的延伸, 并从外部外伸中断开引线。</li>
	<li>隧道铅的内在延伸朝向 IPG 的植入地点。</li>
	<li>将潜在顾客的内部扩展连接到其 IPG。</li>
	<li>用2/0 和1/0 编织合成可吸收缝合材料的简单打断缝线缝合皮下层。</li>
	<li>用较细的可吸收3/0 缝合材料做真皮 subcuticular 缝合, 并应用防腐剂和绷带。在这一步, 管理单 IV 剂量扑热息痛 1 gm 和 Tradonal 100 毫克。</li>
</ol>7. 术后护理和后续访问
<ol><li>与临床医生的程序员, 设置编程参数, 根据那些工作最好的在试用期 (步骤 5.7)。</li>
	<li>教病人如何使用程序员25。再次解释神经刺激系统的不同组件。教育病人避免需要过度扭动或伸展的活动。</li>
	<li>在任何程序开始之前, 指示病人总是通知任何医护人员他们有植入神经刺激系统。提供有关警告的说明 (CT 扫描、除颤和复律、烙、碎石、MRI、微波消融和安全筛查装置) 和预防措施 (骨骼生长刺激、牙科演习和超声波探头,神经刺激系统的电解、电磁场设备、激光程序、心理程序、放射治疗和家居用品)。</li>
	<li>确保手术后病人的随访, 检查手术部位感染和适当的麻木覆盖率。</li>
</ol>

<ol>
	<li>Schofferman, J., Reynolds, J., Herzog, R., Covington, E., Dreyfuss, P., O'Neill, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery:+Etiology+and+diagnostic+evaluation.">Failed back surgery: Etiology and diagnostic evaluation.</a> Spine Journal. 3 (5), 400-403 (2003).</li><li>Hazard, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome:+surgical+and+nonsurgical+approaches.">Failed back surgery syndrome: surgical and nonsurgical approaches.</a> Clinical Orthopaedics and Related Research. 443 (443), 228-232 (2006).</li><li>Rigoard, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Algorithmic+Programming+Approach+for+Back+Pain+Symptoms+in+Failed+Back+Surgery+Syndrome+Using+Spinal+Cord+Stimulation+with+a+Multicolumn+Surgically+Implanted+Epidural+Lead:+A+Multicenter+International+Prospective+Study.">An Algorithmic Programming Approach for Back Pain Symptoms in Failed Back Surgery Syndrome Using Spinal Cord Stimulation with a Multicolumn Surgically Implanted Epidural Lead: A Multicenter International Prospective Study.</a> Pain Practice. 15 (3), 195-207 (2015).</li><li>Thomson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome+-+definition,+epidemiology+and+demographics.">Failed back surgery syndrome - definition, epidemiology and demographics.</a> British Journal of Pain. 7 (1), 56-59 (2013).</li><li>Balagu&#233;, F., Mannion, A. F., Pellis&#233;, F., Cedraschi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-specific+low+back+pain.">Non-specific low back pain.</a> Lancet. 379 (9814), 482-491 (2012).</li><li>Melzack, R., Wall, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain+Mechanisms:+A+New+Theory.">Pain Mechanisms: A New Theory.</a> Science. 150 (3699), 971-979 (1965).</li><li>Gonz&#225;lez, J. C. A., Melzack, R., Wall, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+gate+theory:+Beyond+the+scientific+concept+two+worlds+scientists+dedicated+to+the+understanding+of+pain.">The gate theory: Beyond the scientific concept two worlds scientists dedicated to the understanding of pain.</a> Revista de la Sociedad Espanola del Dolor. 20 (4), 191-202 (2013).</li><li>Loeser, D., John, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concepts+of+pain.">Concepts of pain.</a> The Lancet. 353 (May 8), 1607-1609 (1992).</li><li>Cui, J. G., Linderoth, B., Meyerson, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+spinal+cord+stimulation+on+touch-evoked+allodynia+involve+GABAergic+mechanisms.+An+experimental+study+in+the+mononeuropathic+rat.">Effects of spinal cord stimulation on touch-evoked allodynia involve GABAergic mechanisms. An experimental study in the mononeuropathic rat.</a> Pain. 66 (2-3), 287-295 (1996).</li><li>Song, Z., Meyerson, B. A., Linderoth, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Muscarinic+receptor+activation+potentiates+the+effect+of+spinal+cord+stimulation+on+pain-related+behavior+in+rats+with+mononeuropathy.">Muscarinic receptor activation potentiates the effect of spinal cord stimulation on pain-related behavior in rats with mononeuropathy.</a> Neuroscience Letters. 436 (1), 7-12 (2008).</li><li>Song, Z., Meyerson, B. A., Linderoth, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+5-HT+receptors+that+contribute+to+the+pain-relieving+effects+of+spinal+cord+stimulation+in+a+rat+model+of+neuropathy.">Spinal 5-HT receptors that contribute to the pain-relieving effects of spinal cord stimulation in a rat model of neuropathy.</a> Pain. 152 (7), 1666-1673 (2011).</li><li>Waszak, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+Cord+Stimulation+in+Failed+Back+Surgery+Syndrome:+Review+of+Clinical+Use,+Quality+of+Life+and+Cost-effectiveness.">Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-effectiveness.</a> Asian Spine Journal. 10 (6), 1195-1204 (2016).</li><li>Kishima, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulation+of+neuronal+activity+after+spinal+cord+stimulation+for+neuropathic+pain;+H(2)15O+PET+study.">Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study.</a> Neuroimage. 49 (2), 2564-2569 (2010).</li><li>Stanc&#225;k, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+magnetic+resonance+imaging+of+cerebral+activation+during+spinal+cord+stimulation+in+failed+back+surgery+syndrome+patients.">Functional magnetic resonance imaging of cerebral activation during spinal cord stimulation in failed back surgery syndrome patients.</a> European Journal of Pain (London, England). 12 (2), 137-148 (2008).</li><li>Yang, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bipolar+spinal+cord+stimulation+attenuates+mechanical+hypersensitivity+at+an+intensity+that+activates+a+small+portion+of+A-fiber+afferents+in+spinal+nerve-injured+rats.">Bipolar spinal cord stimulation attenuates mechanical hypersensitivity at an intensity that activates a small portion of A-fiber afferents in spinal nerve-injured rats.</a> Neuroscience. 199, 470-480 (2011).</li><li>North, R. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+stimulation+versus+re-operation+in+patients+with+failed+back+surgery+syndrome:+an+international+multicenter+randomized+controlled+trial+(EVIDENCE+study).">Spinal cord stimulation versus re-operation in patients with failed back surgery syndrome: an international multicenter randomized controlled trial (EVIDENCE study).</a> Neuromodulation: Journal of the International Neuromodulation Society. 14, 330-335 (2011).</li><li>Kapural, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+10-kHz+High-Frequency+and+Traditional+Low-Frequency+Spinal+Cord+Stimulation+for+the+Treatment+of+Chronic+Back+and+Leg+Pain:+24-Month+Results+From+a+Multicenter,+Randomized,+Controlled+Pivotal+Trial.">Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial.</a> Neurosurgery. 79 (5), 667-677 (2016).</li><li>Remacle, T. Y., Bonhomme, V. L., Renwart, H. J. P., Remacle, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Multicolumn+Lead+Spinal+Cord+Stimulation+on+Low+Back+Pain+in+Failed+Back+Surgery+Patients:+A+Three-Year+Follow-Up.">Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.</a> Neuromodulation: Technology at the Neural Interface. 20 (7), 668-674 (2017).</li><li>Veizi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+Cord+Stimulation+(SCS)+with+Anatomically+Guided+(3D)+Neural+Targeting+Shows+Superior+Chronic+Axial+Low+Back+Pain+Relief+Compared+to+Traditional+SCS-LUMINA+Study.">Spinal Cord Stimulation (SCS) with Anatomically Guided (3D) Neural Targeting Shows Superior Chronic Axial Low Back Pain Relief Compared to Traditional SCS-LUMINA Study.</a> Pain Medicine (Malden, Mass). 18 (8), 1534-1548 (2017).</li><li>Chan, C., Peng, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome.">Failed back surgery syndrome.</a> Pain Medicine. 12 (4), 577-606 (2011).</li><li>Hawker, G., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain.">Measures of adult pain.</a> Arthritis Care and Research. 63 (11), 240-252 (2011).</li><li>Deer, T. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Neurostimulation+Appropriateness+Consensus+Committee+(NACC)+Safety+Guidelines+for+the+Reduction+of+Severe+Neurological+Injury.">The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury.</a> Neuromodulation. 20 (1), 15-30 (2017).</li><li>Gupta, P., Kumar, A., Kumar, A., Goel, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+Spinal+Cord+Anomalies:+A+Pictorial+Review.">Congenital Spinal Cord Anomalies: A Pictorial Review.</a> Current Problems in Diagnostic Radiology. 42 (2), 57-66 (2013).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic N'VISION&#174; Programmer Quick Guide. , (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic MyStim&#174; Programmer Quick Guide. , (2014).</li><li>Frey, M. E., Manchikanti, L., Benyamin, R. M., Schultz, D. M., Smith, H. S., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+stimulation+for+patients+with+failed+back+surgery+syndrome:+a+systematic+review.">Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review.</a> Pain Physician. 12 (2), 379-397 (2009).</li></ol>

作者没有什么可透露的。

最近的研究表明, SCS 可以可靠地改善 FBSS 患者的不同疼痛成分, 提高他们的生活质量 (如睡眠质量和体力活动), 这些好处是持续的长期随访3,17,18,19。
根据疼痛的定位, 我们使用不同的方法。当患者只有单边 LP, 经皮穿刺8接触铅放置在后脊髓硬膜外空间透视成像和最终位置的?...

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。在建立 FBSS 之前, 其他条件, 如持续神经根压迫, 永久性神经根损伤作为原压缩或手术的结果, 蛛网膜炎, 错误的初步诊断, 并记录机械原因腰痛 (如脊柱不稳定, 后关节骨关节炎, spondylolysthesis, 腰痛疼痛), 应排除1,2,3。FBSS 患者可能有严重或残疾的神经病理性疼痛, 该综合征是令人不安的, 因为它是慢性和抗常规治疗。其发病率和患病率与类风湿性关节炎4相似。因此, 它是5工业化社会的一个巨大负担。
脊髓刺激 (scs) 背侧硬膜外引线可用于治疗背部疼痛 (BP) 和腿部疼痛 (LP) 的 FBSS 患者, 虽然 SCS 疼痛缓解机制尚未充分调查。根据 Melzack 和帕特里克墙在1965年首次提出的门控理论, 大脑监视着一个微小神经网络的活动, 它沿脊髓的背角分布, 受伤害调节, 而且非伤害传入6。当强烈的触觉刺激被应用到同一个地方7,8时, 这些复杂电路在脊髓的浅背角负责减轻在身体的一个特定位置的痛苦。然而, 一些研究表明, SCS 不仅依赖于这个理论。据报道, 几种神经递质 (乙酰胆碱、伽玛丁酸和血清素) 在 SCS 机制9、10、11、12以及许多脑区都有作用。13,14和不同的脊髓纤维15。
SCS 设备包括硬膜外引线、内部脉冲发生器 (IPG) 和用于将引线连接到 IPG 的扩展电缆。刺激设置由外部遥控器调整。可使用两种电极, 即经皮穿刺和手术导通。
在过去发表的研究 (包括证据研究16) 中, SCS 在改善 FBSS 根 LP 成分方面的功效已经得到证实, 最近两项新技术已证明对 BP 的治疗是有效的。成分, 这是众所周知的是顽固的 SCS。第一个是高频刺激17。第二个是手术用的3,18。前者的主要缺点是, 他们的电池需要更频繁的充电和编程优化是挑战的更长的 "洗涤" 时间19。后者的技术比经皮高频刺激技术更具侵入性, 因为它需要一个小的椎板切除术, 使得围手术麻木在局部麻醉下具有挑战性, 尽管可能3。事实上, 这个程序可以在局部麻醉下进行, 辅以有意识镇静或脊椎麻醉3。在我们的机构, 当针对 FBSS 患者的背部疼痛, 我们把这样的手术线索通过一个小椎板切除在10胸水平与病人全麻。3年随访18, 证明了该方法与多列导线治疗 FBSS 患者的 LP 和 BP 的持久疗效。下面给出了我们的方法的详细协议。

<table><tbody><tr><td>16-20 GA needle</td><td>BD Insyte- W</td><td></td><td></td></tr><tr><td>NaCl 0.9% 1 L</td><td>Baxter</td><td>AKE1324</td><td></td></tr><tr><td>Iso-betadine Dermic (500mL)</td><td>MEDA</td><td>09461.16</td><td></td></tr><tr><td>Iso-betadine Soap (500mL)</td><td>MEDA</td><td>09462.10</td><td></td></tr><tr><td>Iso-betadine hydroalcoolic (125 mL)</td><td>MEDA</td><td>41534.1</td><td></td></tr><tr><td>Ziehm Vision R FD</td><td>Ziehm Imaging Inc.</td><td>CB05183</td><td></td></tr><tr><td>Marcain 0.5% + adrenaline 1/200.000 20 mL</td><td>Astrazenca</td><td>PA 970/46/2</td><td>0.5% Bupivacaine/1:200,000 adrenaline solution&amp;nbsp;</td></tr><tr><td>external Neurostimulator (eNs)&amp;nbsp;</td><td>&amp;nbsp;Medtronic Inc., MN, USA</td><td>37022</td><td></td></tr><tr><td>Trousse de colonne lombaire CHR Citadelle (Procedure pack)&amp;nbsp;</td><td>M&amp;ouml;lnlycke</td><td>97061425-01</td><td></td></tr><tr><td>OR Table</td><td>Maquet</td><td>1150.30D0</td><td></td></tr><tr><td>OR Lights</td><td>Trumpf</td><td>1929278</td><td></td></tr><tr><td>Specify SureScan MRI</td><td>&amp;nbsp;Medtronic Inc., MN, USA</td><td>977C165</td><td>Multicolumn lead</td></tr><tr><td>Primeadvanced surescan mri neurostimulator&amp;nbsp;</td><td>&amp;nbsp;Medtronic Inc., MN, USA</td><td>97702</td><td>Internal Pulse Generator</td></tr><tr><td>Monocryl 3/0</td><td>Ethicon</td><td>Y423</td><td></td></tr><tr><td>Polysorb 2/0</td><td>Covidien</td><td>GL123</td><td></td></tr><tr><td>Polysorb 1</td><td>Covidien</td><td>CL535</td><td></td></tr><tr><td>Polysorb 2</td><td>Covidien</td><td>CL055</td><td></td></tr><tr><td>Cutiplast Steril 20x10 cm</td><td>Smith&amp;amp;Nephew</td><td>66001475</td><td>Bandage</td></tr><tr><td>MyStim Programmer</td><td>&amp;nbsp;Medtronic Inc., MN, USA</td><td>97740</td><td></td></tr><tr><td>FixoCath</td><td>Pajunk</td><td>001151-37Z</td><td></td></tr><tr><td>N&#039;Vision Programmer&amp;nbsp;</td><td>&amp;nbsp;Medtronic Inc., MN, USA</td><td>8840</td><td></td></tr><tr><td>3M Tegaderm Film 10x12cm</td><td>3M Deutschland GmbH</td><td>1626W</td><td></td></tr><tr><td>Extension Kit</td><td>Medtronic Inc., MN, USA</td><td>37081-40</td><td></td></tr><tr><td>Paracetamol</td><td>Fresenius Kabi</td><td></td><td></td></tr><tr><td>Tradonal&amp;nbsp;</td><td>Meda Pharma</td><td></td><td></td></tr><tr><td>Sufentanil</td><td>Janssen- Cilag</td><td></td><td></td></tr><tr><td>Propolipid 1%</td><td>Fresenius Kabi</td><td></td><td></td></tr><tr><td>Ketalar (Ketamine Hydrochloride)</td><td>Pfizer</td><td></td><td></td></tr><tr><td>Rocuronium Bromide</td><td>Bbraun</td><td></td><td></td></tr><tr><td>Cefazolin</td><td>Milan</td><td></td><td></td></tr></tbody></table>

treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation

失败的背部手术综合征 (FBSS) 指脊柱手术后持续的慢性疼痛。脊髓刺激的背侧硬膜外引线可用于治疗背部和腿部疼痛的 FBSS 患者。本文提出了在 FBSS 患者中应用脊髓刺激术治疗线索的详细方案。在我们的部门, 病人在全身麻醉下, 我们在硬膜外的空间, 通过一个小椎板切除在10胸部水平的铅。铅的放置后, 一个1月的试用期与外部的铅。如果在这1月的刺激试验结束时止痛大于 50% (比利时报销标准要求), 则将内部脉冲发生器置于皮肤下, 并在第二个手术过程中与铅连接。我们已经证明, 使用这种技术在严格选择的 FBSS 患者可以显著改善背部疼痛, 腿部疼痛, 病人的活动, 和生活质量持续一段时间。

在我中心, 比利时列日的 Citadelle, 最近在调节18发表了一项前瞻性的, 非随机的, 对照研究62例被植入多列铅的连续 FBSS 患者。所有患者都曾进行过脊柱手术, 已筛查可能导致其疼痛的次要原因, 并对最佳的医疗治疗是不难的。在全身麻醉的透视控制下, 62 例患者在中线位置 T8-T9 的投射中放置了几列手术线索。在试验期结束时, 五十四例患者 (87%) 有 > 50% 的疼?...

Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

多列铅脊髓刺激术后腰痛的治疗

本文提出了一种利用脊髓刺激治疗失败后手术患者神经病理性腰痛的方法。

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

treating-low-back-pain-failed-back-surgery-patients-with-multicolumn

Research

JoVE Journal

Behavior

14.4K 次观看.  CHR Citadelle. 本文提出了一种利用脊髓刺激治疗失败后手术患者神经病理性腰痛的方法。

视频: Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

背柱与双并行使用专用电源的信息Steerability，计算模型

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

科研

医学

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

脊髓损伤后下肢电刺激训练的模式

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

行为学

Experimental Strategies to Bridge Large Tissue Gaps in the Injured Spinal Cord after Acute and Chronic Lesion

After a spinal cord injury (SCI) a scar forms in the lesion core which hinders axonal regeneration. Bridging the site of injury after an insult to the spinal cord, tumor resections, or tissue defects resulting from traumatic accidents can aid in facilitating general tissue repair as well as regenerative growth of nerve fibers into and beyond the affected area. Two experimental treatment strategies are presented: (1) implantation of a novel microconnector device into an acutely and completely transected thoracic rat spinal cord to readapt severed spinal cord tissue stumps, and (2) polyethylene glycol filling of the SCI site in chronically lesioned rats after scar resection. The chronic spinal cord lesion in this model is a complete spinal cord transection which was inflicted 5 weeks before treatment. Both methods have recently achieved very promising outcomes and promoted axonal regrowth, beneficial cellular invasion and functional improvements in rodent models of spinal cord injury.
The mechanical microconnector system (mMS) is a multi-channel system composed of polymethylmethacrylate (PMMA) with an outlet tubing system to apply negative pressure to the mMS lumen thus pulling the spinal cord stumps into the honeycomb-structured holes. After its implantation into the 1 mm tissue gap the tissue is sucked into the device. Furthermore, the inner walls of the mMS are microstructured for better tissue adhesion.
In the case of the chronic spinal cord injury approach, spinal cord tissue - including the scar-filled lesion area - is resected over an area of 4 mm in length. After the microsurgical scar resection the resulting cavity is filled with polyethylene glycol (PEG 600) which was found to provide an excellent substratum for cellular invasion, revascularization, axonal regeneration and even compact remyelination in vivo.

Severe spinal cord injuries often result in tissue defects. Two possibilities are described to successfully bridge such gaps to promote tissue adaptation, regenerative responses and functional improvement in rats via implantation of a mechanical microconnector system after acute injury and five weeks after complete spinal cord transection.

实验策略急，慢性损伤后桥的损伤脊髓组织大差距

After a spinal cord injury (SCI) a scar forms in the lesion core which hinders axonal regeneration. Bridging the site of injury after an insult to the ...

神经科学

Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique

Lateral interbody fusion provides a significant biomechanical advantage over the traditional transforaminal lumbar interbody fusion due to the large implant size and optimal implant position. However, current methods for lateral interbody cage placement require either a two-staged procedure or a single lateral decubitus position that precludes surgeons from having either full access to the posterior spine for direct decompression or comfortable pedicle screw placement.
Herein is one institution's experience with 10 cases of a prone single-position approach for simultaneous access to the anterior and posterior lumbar spine. This allows both lateral lumbar interbody cage placement, direct posterior decompression, and pedicle screw placement, all in one position. Three-dimensional (3D) navigation is utilized for increased precision in both approaching the lateral spine and interbody cage placement. The traditional blind psoas muscle tubular dilation was also modified. Tubular retractors and lateral vertebral body retractor pins were used to minimize the risks to the lumbar plexus.

The single-position, prone, lateral approach allows for both lateral lumbar interbody placement and direct posterior decompression with pedicle screw placement in one position.

三维导航引导，俯卧，单位，侧腰椎椎体间融合技术

Lateral interbody fusion provides a significant biomechanical advantage over the traditional transforaminal lumbar interbody fusion due to the large ...

Spinal Shortening Surgery for Lumbosacral Nerve Bowstring Disease: A Surgical Technique

Lumbosacral nerve bowstring disease (LNBD) is a syndrome of neurological symptoms caused by differences in the development speed of lumbosacral bone tissue and nerve tissue, which result in a longitudinal stretch of the slow-growing nerve tissue. LNBD is usually caused by congenital factors and accompanied by other lumbosacral diseases, such as lumbar spinal stenosis, lumbar spondylolisthesis, and iatrogenic factors. The main symptoms of LNBD are lower extremity neurological symptoms and fecal dysfunction. The conservative treatment of LNBD includes rest, functional exercise, and drug therapy, but it usually fails to achieve satisfactory clinical results. Few studies have reported on the surgical treatment of LNBD. In this study, we used posterior lumbar interbody fusion (PLIF) to shorten the spine (0.6-0.8mm/segment). This reduced the axial tension of the lumbosacral nerves and relieved the patient's neurological symptoms. We report on the case of a 45 year old male patient whose main symptoms were left lower extremity pain, decreased muscle strength, and hypoesthesia. The above symptoms were significantly relieved 6 months after surgery.

Lumbosacral nerve bowstring disease (LNBD) is a syndrome comprising a series of neurological symptoms caused by high axial tension of the lumbosacral nerve due to congenital, iatrogenic, and other factors. Here, we introduce a surgical technique for the treatment of LNBD through spinal shortening surgery.

Lumbosacral nerve bowstring disease (LNBD) is a syndrome of neurological symptoms caused by differences in the development speed of lumbosacral bone ...

Anterior Cervical Hybrid Decompression and Fusion Surgery to Treat Multilevel Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) is a common disease resulting from intervertebral disc herniation, ossification of the posterior longitudinal ligament, and other pathological changes that cause spinal cord compression. CSM progresses insidiously with mild upper-limb numbness, which patients tend to ignore. As the condition worsens, the patients may experience a limp, limited fine motor activity, and eventually, a loss of daily activity. Conservative treatments, such as physical therapy and medication, are frequently ineffective for CSM. Once surgery is deemed to be required, decompression surgery is the best option. So far, both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have been commonly used to treat CSM. In addition, a type of hybrid procedure that combines ACDF with ACCF has been used to treat some CSM cases and achieved satisfying results. Thus, this study aims to introduce this hybrid surgical technique and advocate for it based on its patient success.

This paper describes a hybrid surgical technique that combines anterior cervical discectomy and fusion with anterior cervical corpectomy and fusion to treat patients with multilevel cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is a common disease resulting from intervertebral disc herniation, ossification of the posterior longitudinal ...

Effects of Manual Therapy on a Chronic Non-Specific Low Back Pain Murine Model

Manual Therapy for a Chronic Non-Specific Low Back Pain Rat Model

Chronic low back pain (CLBP) is a highly prevalent condition worldwide and a major cause of disability. The majority of patients with CLBP are diagnosed with chronic non-specific low back pain (CNLBP) due to an unknown pathological cause. Manual therapy (MT) is an integral aspect of traditional Chinese medicine and is recognized as Tuina in China. It involves techniques like bone-setting and muscle relaxation manipulation. Despite its clinical efficacy in treating CNLBP, the underlying mechanisms of MT remain unclear. In animal experiments aimed at investigating these mechanisms, one of the main challenges is achieving normative MT on CNLBP model rats. Improving the stability of finger strength is a key issue in MT. To address this technical limitation, a standardized procedure for MT on CNLBP model rats is presented in this study. This procedure significantly enhances the stability of MT with the hands and alleviates common problems associated with immobilizing rats during MT. The findings of this study are of reference value for future experimental investigations of MT.

This study proposes a standardized procedure for manual therapy on chronic low back pain model rats, which will be of reference value for future experimental research on manual therapy.

Chronic low back pain (CLBP) is a highly prevalent condition worldwide and a major cause of disability. The majority of patients with CLBP are diagnosed ...

治疗腰椎狭窄和对侧突出的 3 通道内窥镜技术

The Third Channel-Assisted Unilateral Biportal Endoscopic Technique for Lumbar Spinal Stenosis Combined with Contralateral Disc Herniation

Unilateral biportal endoscopic (UBE) spine surgery is an emerging minimally invasive surgical (MIS) technique that has gained popularity for treating lumbar spinal stenosis, particularly in Eastern Asia. The traditional UBE technique, with two portals on one side, can achieve successful unilateral laminotomy for bilateral decompression (ULBD) and, therefore, demonstrates favorable clinical outcomes. However, in the case of lumbar spinal stenosis combined with contralateral disc herniation, it is very difficult to remove the contralateral disc herniation, especially the loose disc fragment within the deep disc. Here, a third channel of the traditional UBE technique was developed to do the discectomy within the ipsilateral endoscopic vision, with which the instruments can go vertically into the contralateral disc, allowing easy discectomy. This technique can not only achieve adequate decompression of the bilateral spinal canal but also effectively remove contralateral herniated disc fragments. This technique avoids performing another UBE procedure on the opposite side, which can potentially shorten the duration of the operation, minimize blood loss and tissue damage, and ensure sufficient neural decompression. This paper will introduce the indications and surgical operation procedures, as well as present a classical case report and follow-up data, to facilitate the application of the third channel-assisted UBE (T-UBE) technique for spine surgeons.

作者聚焦：揭示 TUBE 技术在脊柱手术中的潜力

Here, we present the third channel-assisted UBE technique, which allows for the vertical removal of herniated disc fragments. This technique can effectively address the limitations of traditional UBE techniques. This article will systematically elaborate on this procedure.

第三种通道辅助单侧双门静脉内窥镜技术治疗腰椎管狭窄合并对侧椎间盘突出症

Unilateral biportal endoscopic (UBE) spine surgery is an emerging minimally invasive surgical (MIS) technique that has gained popularity for treating ...

多列铅脊髓刺激术后腰痛的治疗

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背柱与双并行使用专用电源的信息Steerability，计算模型

脊髓损伤后下肢电刺激训练的模式

实验策略急，慢性损伤后桥的损伤脊髓组织大差距

三维导航引导，俯卧，单位，侧腰椎椎体间融合技术

Spinal Shortening Surgery for Lumbosacral Nerve Bowstring Disease: A Surgical Technique

Anterior Cervical Hybrid Decompression and Fusion Surgery to Treat Multilevel Cervical Spondylotic Myelopathy

Manual Therapy for a Chronic Non-Specific Low Back Pain Rat Model

第三种通道辅助单侧双门静脉内窥镜技术治疗腰椎管狭窄合并对侧椎间盘突出症

第三种通道辅助单侧双门静脉内窥镜技术治疗腰椎管狭窄合并对侧椎间盘突出症

第三种通道辅助单侧双门静脉内窥镜技术治疗腰椎管狭窄合并对侧椎间盘突出症