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プロトコルは、Nanoori 病院の人間研究倫理委員会のガイドラインに従います。書面によるインフォームド コンセントは、腰椎椎間板の脱出による一方的な下下肢神経根障害を持つすべての患者から得られました。除外基準は、区域の不安定性の存在、すべり症 (グレード 1 以上)、および重要な脊柱管狭窄症の存在だった。
1. 患者位置と皮膚マーキング
<ol><li>わずかな屈曲で背骨と radiolucent オペレーティング テーブルの上腹臥位で患者を置きます。 注: 患者の外科のための徴候は次のとおり: 難治性、頻繁に一方的な保守的に神経根障害耐性対策 (少なくとも 6-8 週間)、関連付けられた軸のバックの有無痛み、身体検査、上の肯定的な張力標識や神経根症確証の MRI 研究で明らかに相関関連づけること。</li>
	<li>マーキング ペン イメージインテンシファイアの下で腸骨稜の範囲だけでなく、背骨の正中線をマークします。</li>
	<li>手動バック評価方法6を使用してディスク領域の中心に沿って傍脊柱皮膚エントリ ポイントをマーク: 背中の筋肉と腹筋の境界線をチェックします。両方中間のディスク レベル前後 (AP) のこの境界線の内側皮膚エントリ ポイントをマークし、横方向の x 線。</li>
</ol>2. 局所麻酔・切開
<ol><li>エントリ ポイントの周囲皮下の局所麻酔薬 (1% リドカイン 2 mL) に潜入し、約 1 cm の皮膚切開を行う 23 G 針で局所麻酔薬 (1% リドカインの 3 mL) 軌道に潜入します。</li>
	<li>皮膚切開 18 G 脊髄針を水平に 25-35 ° の角度で挿入します。</li>
	<li>イメージ ・ インテンシファイヤー筋や背中の筋肉の下に針を渡します。その後、椎間板の近くの Kambin の三角形で針をドッキングします。 注: Kambin の三角形ディスクの後外側面ではあります。斜辺は既存の神経根、下の椎体の上縁は、高さが thecal sac/横断神経根。</li>
	<li>イメージインテンシファイアの下で造影剤の 1.5 mL を注入することにより Kambin の三角形で無料の硬膜外腔を確認してください。1.6% リドカイン (8 mL の生理食塩水 2 mL とエピネフリン 0.05 mL 2% リドカイン) の 2-4 mL のブースター注入による椎間孔スペースと、1% リドカインの 8-10 mL を注入することにより Kambin の三角形で局所麻酔を提供する最初の注射後の 4-5 分。</li>
</ol>3 ディスコグラフィー
<ol><li>透視下椎間板のスペースに針を挿入し、コントラスト和え 0.8% インディゴ カルミネの 2 mL を注射することによって作品を実行します。</li>
</ol>4. 内視鏡の挿入
<ol><li>針を椎間板のスペースにガイドワイヤーを挿入し、針を削除します。</li>
	<li>挿入したガイドワイヤーを通して Kambin の三角形で閉鎖をスライドさせ、ディスク スペースの表面にアンカーします。</li>
	<li>Obturator を通じて作業のカニューレを挿入し、その後、Kambin の三角形に内視鏡を導入します。 注: 作業カニューレは外径 8 mm の傾斜型です。内視鏡は、表示角度、7.3 mm 外径、4.7 mm 作業チャネル、251 mm 全長の 30 ° を持っています。一定の生理食塩水灌漑を使用して全体のプロシージャが実行されます。</li>
</ol>5. 手術
<ol><li>ディスク (図 1 a) 入国前に内視鏡で Kambin の三角形の硬膜外脂肪と軟組織を観察します。</li>
	<li>高周波凝固装置を用いた環状上軟部組織と血管をクリアします。環状カッターで環状開窓を行い、内視鏡下で輪を入力してください。 注: アプローチ中に終了し、トラバースの神経根への損傷を避けるためには、処理は継続的なフィードバックを持つ患者から。</li>
	<li>穴あき管内カニューレの面取りの種類を挿入することで硬膜外腔とディスク スペースの半 々 ビューを取得します。 注: 背の半分、半 々、後縦靱帯、硬膜外腔とトラバース神経根、硬膜の見ることができます。腹側の半分にアニュラスと後縦靱帯に腹側のディスクを見ることができます。</li>
	<li>レバー下正確な半 々 を達成するために作業のカニューレは、7 (図 2 aおよび2 b) を表示します。 注: は、ベベル型作業カニューレを使用して、簡単じゃない既存の神経根を安全に操作する初心者のためラウンド作業カニューレもできますので (図 3) を使用します。</li>
</ol>6. ターゲット Fragmentectomy
<ol><li>椎間板を十分に伸長した後症候性ディスク領域に向けての軌道を変更します。 注: 作業チャネルは劣るで移行したディスクの高運河侵害されたディスクで硬膜外腔と、優れた移行ディスク (図 3) で椎間孔領域の suprapedicular 切り込みに向かって送られます。</li>
	<li>ディスクのすべての空きフラグメント チェックして浮遊硬膜嚢、既存ルートとトラバース ルート削除、回転作業チャネルと内視鏡による硬膜外腔を無料を確認します。 注: すべての患者は、(図 4および図 5) 手術翌日に MRI を受けます。</li>
</ol>

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著者が明らかに何もありません。

研究は、当研究所の管理下にあった 184 腰椎椎間板疾患患者の将来の分析に基づいています。X 線イメージング、計算された断層レントゲン写真撮影 (CT) や磁気共鳴画像 (MRI) は全例診断を確定し、他の疾患を除外するために行われました。CT や MRI スキャンで示される結果は、神経学的検査と相関しました。適切な診断後患者は PETLD のモバイル アウトサイドイン手法でに作動しました。除外?...

fChronic 腰痛と足の痛みは、どんな社会で一般的な病気です。腰椎椎間板症の治療法は、絶えず進化しています。装備一式は広い、開腹手術と microlumbar 椎間板切除術および今内視鏡ルート1,2,3,4に固定されています。Parvez Kambin によって最初に提案された切開経路は、介護5,6、7の標準を徐々 になっています。完全内視鏡下脊椎手術の利点は、少ない軟部組織解離、少ない出血、減らされた病院受付日、早期の機能回復、8生活の質の向上です。
シューベルトとフォルテ4によって与えられる PETLD の伝統的な外のアプローチはリーマを使用して作業カニューレ孔に導入し、孔の拡大を扱っています。外のアプローチの新たな手法の背後にある理論的根拠は、それ依存しないことだけすべてのケースで孔を拡大する方法をここでは言及しました。テクニックは、作業カニューレ孔し、内視鏡9,10の下で、ターゲット フラグメントへのカニューレの動き内の正確な配置について説明します。解剖学的, 切開空間に 3 つの異なるルートがあるし、外の技術と経皮的内視鏡下脊椎手術を腰椎椎間板ヘルニアの広い範囲に適用できる効果的に使用されている場合。中央、傍、および危険にさらされた乳酸脱水素酵素 (LDH) は椎間ルートによって近づかれる高い運河椎間孔、遠く外側上方に移行した LDH は椎間孔のルートによって近づかれ、下方に移行した LDH は suprapedicular ルート6によって近づかれます。この手法の利点は、少ない椎間板損傷と通常の解剖学的構造を保持、硬膜外の露出が容易で作業カニューレ孔での操作は困難ではないです。説明する手法は、孔内の構造の正確なビジョンを提供し、孔の拡大ではなく、孔内カニューレの正確な配置に焦点を当てていますので、以前のものとは異なります。テクニックはインサイド アウト手法として同様に安全構造、特に押し出しフラグメントの扱いやすさを提供しています。本研究の目的は、移行、上下中央、傍、椎間孔、遠い外側椎間板脱出のさまざまな種類の管理にこの手法の汎用性を証明し、高運河を危険にさらす場合です。技術はただし、長い学習曲線を要求し、初心者が学びながら患者をする必要がありますので。

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			<td height="20" style="height:20px;width:176px;">Contrast dye injection</td>
			<td style="width:347px;">Iobrix injection, Taejoon pharm,Seoul, Korea</td>
			<td align="right" style="width:65px;">S.No. 1</td>
			<td style="width:64px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">0.8% indigo carmine</td>
			<td>Carmine, Korea United Pharmaceutical, Yoenki, Korea</td>
			<td align="right">S.No. 2</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:176px;">30 degree endoscope</td>
			<td>Joimax GmbH, Germany</td>
			<td align="right">S.No. 3</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Radiofrequency coagulator</td>
			<td>Elliquence, New York, USA</td>
			<td align="right">S.No. 4</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Drill</td>
			<td>Primado 2 NSK, Tochigi, Japan</td>
			<td align="right">S.No. 5</td>
			<td></td>
		</tr>
	</tbody>
</table>

a mobile outside-in technique of transforaminal lumbar endoscopy for lumbar disc herniations

経皮的内視鏡的切開腰椎椎間板切除術 (PETLD) は、腰椎椎間板疾患の管理の標準となっています。ディスクに関して作業カニューレの導入のための 2 つの方法があります-アウトサイドイン、インサイド アウト。この前向き研究の目的は、モバイル アウトサイドイン手法椎間板脱出のさまざまな種類をあつかう上での技術的側面を説明します。腰椎椎間板脱出のため片側下下肢神経根障害と 184 の連続した患者の合計は、PETLD のモバイル アウトサイドイン手法でに作動しました。その臨床結果は、Macnab 基準オスウェストリー障害索引 (ODI)、ビジュアル アナログ スケール (VAS) 足の疼痛スコアを有した椎間板脱出の種類に基づいて評価しました。減圧の完全性は、磁気共鳴イメージングの術後で文書化されました。患者の平均年齢は 50 ± 16 歳、男女比 2:1 であった。平均観察期間 19 ± 6 ヵ月であった。合計 190 腰椎レベルで作動した (L1-L2: n = 4、L2-L3: n = 17、L3-L4: n = 27、L4-5: n = 123 と L5-S1: n = 19)。種類に分け、患者の分布は中央: n = 14、傍: n = 74、椎間孔: n = 28、遠く外側: n = 13、優れた移行: n = 8、下移行: n = 38、および高い運河妥協: n = 9。平均手術時間は 35 ± 12 (25-56) 分と平均入院 (1-3) 日 1.2 ± 0.5 であった。足の痛みの VAS スコア改善 7.5 ± 1 から 1.7 ± 0.9.70 ± から改善、ODI 8.3 を 23 ± 5。Macnab の基準に従って 75 例 (40.8%) は優秀な結果を持っていた、104 例 (56.5%) 良い結果が出て、5 例 (2.7%) は公正な結果を持っていた。(7.89%) で作動した 190 レベル 15 で再発 (初期および後期を含む) を見た。この記事では、モバイルの方法で孔内の高精度着陸に依存して、孔の拡大にのみ依存しない小説外のアプローチを示します。アプリケーションで汎用性の高い、椎間板脱出のすべてのタイプの管理では、厳しい運河妥協や高移行にも便利です。

アウトカム評価:
手術の結果は、VAS 脚痛みスコア11、12ODI および Macnab 基準13により測定しました。これらは術前の期間のフォロー アップ訪問 (外科手術の後、最後のフォロー アップに 3 ヵ月後 1 週) の間に測定した.
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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

腰椎椎間板ヘルニアの切開腰椎内視鏡外でモバイルの技術

腰椎椎間板ヘルニアの切開内視鏡椎間板切除術の新たなアウトサイドイン手法のプロトコルをご紹介します。184 患者治療の結果、使用の広い適応手法の技術的な側面は、詳細に説明します。

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

a-mobile-outside-technique-transforaminal-lumbar-endoscopy-for-lumbar

Research

JoVE Journal

Medicine

11.7K ビュー.  Nanoori Hospital. 腰椎椎間板ヘルニアの切開内視鏡椎間板切除術の新たなアウトサイドイン手法のプロトコルをご紹介します。184 患者治療の結果、使用の広い適応手法の技術的な側面は、詳細に説明します。

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

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods of FMT administration have been reported in the literature including nasogastric tube, upper endoscopy, enema and colonoscopy. FMT via colonoscopy yields excellent cure rates and is also well tolerated. We have found that patients find this an acceptable and tolerable mode of delivery. At our Center, we have initiated a fecal transplant program for patients with recurrent or refractory CDI. We have developed a protocol using an iterative process of revision and have performed 24 fecal transplants on 22 patients with success rates comparable to the current published literature. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool maximizes therapeutic success. Here we detail each step of the FMT protocol that can be carried out at any endoscopy center with a high degree of safety and success.

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation via colonoscopy is a safe and effective treatment for recurrent and refractory C.difficile infection. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool during the colonoscopy will maximize therapeutic success.

再発のための大腸内視鏡検査を経由して糞便細菌叢移植<em&gt; C。ディフィシル</em&gt;感染

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods ...

医学

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

麻酔、手術および収縮法を用いた経肛門用ねじの評価<em&gt;インビボ</em&gt;豚の腰椎モデル

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration have been developed. The ideal animal model should closely mimic the human intervertebral disc with regard to morphology, biomechanical properties and the absence of notochordal cells. The sheep lumbar intervertebral disc model fulfils these criteria. We present an ovine model of intervertebral disc degeneration utilizing a drill bit injury through a lateral retroperitoneal approach. The lateral approach significantly reduces the incision and potential morbidity associated with the traditional anterior approach to the ovine spine. Utilization of a drill-bit method of injury affords the ability to produce a consistent and reproducible injury, of precise dimensions, that initiates a consistent degree of intervertebral disc degeneration. The focal nature of the annular and nucleus pulposus defect more closely mimics the clinical condition of focal intervertebral disc herniation. Sheep recover rapidly following this procedure and are typically mobile and eating within the hour. Intervertebral disc degeneration ensues and sheep undergo necropsy and subsequent analysis at periods from eight weeks. We believe that the drill bit injury model of intervertebral disc degeneration offers advantages over more conventional annular injury models.

Intervertebral disc degeneration is a significant contributor to back pain and a leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration exist. We demonstrate an ovine model of intervertebral disc degeneration, utilizing a drill bit, which achieves a consistent disc injury and reproducible level of disc degeneration.

側方腹腔ドリルビット傷害を利用した羊の腰椎椎間板変性モデル

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous ...

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.

最小侵襲性トランスフォラミン間融合のためのコーンビーム術内コンピュータ断層撮影ベースの画像ガイダンス

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the lower extremities, hyperhidrosis, etc. It is commonly practiced to position the puncture needle tip in front of the anterior fascia of the psoas major muscle and inject the inactivating agent around the sympathetic trunk, which is defined as conventional CLS. Although relatively rare, ureteropelvic damage is the most frequently reported complication of conventional CLS and can cause serious harm to patients. We found that injecting the inactivating agent behind the anterior fascia, which only targets gray rami communicantes, helped achieve therapeutic efficacy in&#160;vasodilation, sweat reduction, and pain relief comparable to conventional CLS, and serious complications were largely reduced. We define this procedure as selective CLS. Here, we present a protocol of selective CLS. The precise needle tract and accurate evaluation of the spreading of the contrast agent are critical to ensure that the drug is injected behind the anterior fascia of the psoas major muscle. The needle tip is at approximately one-third the dividing line of the vertebral body in the lateral view of a lumbar X-ray. The contrast is mainly confined around the needle tip and spreads outward and downward along the psoas muscle fibers. In this way, the anterior fascia provides a natural barrier for the ureteropelvic area, and the psoas major muscle provides a natural barrier for the lumbar nerve root. There are several highlights of this article, including 1) a detailed description of the selective CLS procedures, 2) an explanation of the anatomical basis for the implementation of selective CLS, and 3) an explanation of the differences between selective and conventional CLS.

We present a protocol for selective chemical lumbar sympathectomy (CLS), which inactivates only gray rami communicantes and not the sympathetic trunk. Selective CLS can help achieve therapeutic efficacy in vasodilation, sweat reduction, and pain relief that are comparable to conventional CLS, and serious complications, particularly ureteropelvic damages, can be reduced.

ターゲット灰白交通枝選択的化学腰椎交感神経切除術で

Chemical lumbar sympathectomy (CLS) is a commonly used, minimally invasive procedure for the treatment of conditions including ischemic diseases of the ...

Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion surgery to obtain results about altered variables of gait and posture. These observed changes can then be correlated with the patient-reported outcome measure of pain relief. The rasterstereographic device projects lines of parallel light onto the surface of the tested subject&#39;s back. The deformation of these lines is recognized by the device. From these data, a special software then generates a 3-D profile based on the principle of triangulation. With an inaccuracy of only 0.2 mm it can measure changes in posture at very high precision. Gait and stance parameters are recorded using a treadmill equipped with an electric sensor mat that contains 10,200 miniature force sensors in the registering zone under the belt. Initial walking speed on the treadmill is 0.5 km/h. Speed is then gradually increased by increments of 0.1 km/h until each subject reaches his or her individual maximum well tolerable walking speed. At this speed, parameters are recorded during a 20 s measurement interval. Subjects are tested barefoot and without holding a handrail. Among various other parameters, stride width, step length, stance phase and foot rotation are measured. Both methods used reportedly have a high intra- and inter-observer reliability. The advantage of these highly accurate techniques is that they offer an objective and very detailed perspective on changes in the patient&#39;s posture and gait. Due to the amount of data generated, these techniques are, however, not so much suitable for everyday routine use, but rather interesting to scientifically evaluate long term alterations in posture and gait in patients like for example after lumbar fusion surgery.

Here, we present a protocol to analyze the posture and the gait of patients after lumbar fusion surgery by means of high-resolution video rasterstereography and a treadmill equipped with an integrated sensor mat. Allowing critical functional postoperative evaluation on a less subjective level may enhance accuracy and reliability of indication for surgery.

患者の姿勢と歩行プロフィール ビデオ Rasterstereography とトレッドミル歩行分析による腰椎手術後の評価

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

腰椎椎間板ヘルニア治療のための全内視鏡的隔離ゾーン技術

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

3D Printing Model of a Patient's Specific Lumbar Vertebra

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical field of view but also protect the patient&#39;s spinal nerves from injury. Digital models play an important role in the pre-and intra-operation of SDR, because they can not only make doctors more familiar with the anatomical structure of the surgical site, but also provide precise surgical navigation coordinates for the manipulator. This study aims to create a 3D digital model of a patient-specific lumbar vertebra that can be used for planning, surgical navigation, and training of the SDR operation. The 3D printing model is also manufactured for more effective work during these processes.
Traditional orthopedic digital models rely almost entirely on computed tomography (CT) data, which is less sensitive to soft tissues. Fusion of the bone structure from CT and the neural structure from magnetic resonance imaging (MRI) is the key element for the model reconstruction in this study. The patient&#39;s specific 3D digital model is reconstructed for the real appearance of the surgical area and shows the accurate measurement of inter-structural distances and regional segmentation, which can effectively help in the preoperative planning and training of SDR. The transparent bone structure material of the 3D-printed model allows surgeons to clearly distinguish the relative relationship between the spinal nerve and the vertebral plate of the operated segment, enhancing their anatomical understanding and spatial sense of the structure. The advantages of the individualized 3D digital model and its accurate relationship between spinal nerve and bone structures make this method a good choice for preoperative planning of SDR surgery.

This study aims to create a 3D-printed model of a patient-specific lumbar vertebra, which contains both the vertebra and spinal nerve models fused from high-resolution computed tomography (HRCT) and MRI-Dixon data.

患者の特定の腰椎の3Dプリントモデル

Selective dorsal rhizotomy (SDR) is a difficult, risky, and sophisticated operation, in which a laminectomy should not only expose an adequate surgical ...

Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

顕微鏡支援低侵襲前腰椎椎体間固定術の臨床応用

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for ...