<meta charset="utf8"></head><body>최소 침습 척추 수술로 요추 척추관 협착증 치료

<ol>
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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=Cost-effectiveness+of+multilevel+hemilaminectomy+for+lumbar+stenosis-associated+radiculopathy.">Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy.</a> The Spine Journal. 11 (8), 705-711 (2011).</li><li>Parker, S. 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=Two-year+comprehensive+medical+management+of+degenerative+lumbar+spine+disease+(lumbar+spondylolisthesis,+stenosis,+or+disc+herniation):+a+value+analysis+of+cost,+pain,+disability,+and+quality+of+life.">Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life.</a> Journal of Neurosurgery: Spine. 21 (2), 143-149 (2014).</li><li>Fox, M. W., Onofrio, B. M., Hanssen, A. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+and+radiological+instability+following+decompressive+lumbar+laminectomy+for+degenerative+spinal+stenosis:+a+comparison+of+patients+undergoing+concomitant+arthrodesis+versus+decompression+alone.">Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone.</a> Journal of Neurosurgery. 85 (5), 793-802 (1996).</li><li>J&#246;nsson, B., Annertz, M., Sj&#246;berg, C., Str&#246;mqvist, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+and+consecutive+study+of+surgically+treated+lumbar+spinal+stenosis:+part+II:+five-year+follow-up+by+an+independent+observer.">A prospective and consecutive study of surgically treated lumbar spinal stenosis: part II: five-year follow-up by an independent observer.</a> Spine. 22 (24), 2938-2944 (1997).</li><li>Ghogawala, Z., 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=Laminectomy+plus+fusion+versus+laminectomy+alone+for+lumbar+spondylolisthesis.">Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.</a> New England Journal of Medicine. 374 (15), 1424-1434 (2016).</li><li>Komp, 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=Bilateral+spinal+decompression+of+lumbar+central+stenosis+with+the+full-endoscopic+interlaminar+versus+microsurgical+laminotomy+technique:+a+prospective,+randomized,+controlled+study.">Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study.</a> Pain Physician. 18 (1), 61 (2015).</li><li>Ito, 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=Step-by-step+sublaminar+approach+with+a+newly-designed+spinal+endoscope+for+unilateral-approach+bilateral+decompression+in+spinal+stenosis.">Step-by-step sublaminar approach with a newly-designed spinal endoscope for unilateral-approach bilateral decompression in spinal stenosis.</a> Neurospine. 16 (1), 41 (2019).</li><li>Lee, C. W., Yoon, K. J., Jun, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+endoscopic+laminotomy+with+flavectomy+by+uniportal,+unilateral+approach+for+the+lumbar+canal+or+lateral+recess+stenosis.">Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis.</a> World Neurosurgery. 113, e129-e137 (2018).</li><li>McGrath, L. B., White-Dzuro, G. A., Hofstetter, C. P. <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+clinical+outcomes+following+minimally+invasive+or+lumbar+endoscopic+unilateral+laminotomy+for+bilateral+decompression.">Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression.</a> Journal of Neurosurgery: Spine. 30 (4), 491-499 (2019).</li><li>Pairuchvej, S., Muljadi, J. A., Ho, J. C., Arirachakaran, A., Kongtharvonskul, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Full-endoscopic+(bi-portal+or+uni-portal)+versus+microscopic+lumbar+decompression+laminectomy+in+patients+with+spinal+stenosis:+systematic+review+and+meta-analysis.">Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis.</a> European Journal of Orthopaedic Surgery &amp; Traumatology. 30, 595-611 (2020).</li><li>Kim, H. S., Wu, P. H., Jang, I. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+endoscopic+unilateral+laminotomy+for+bilateral+decompression+outside-in+approach:+a+proctorship+guideline+with+12+steps+of+effectiveness+and+safety.">Lumbar endoscopic unilateral laminotomy for bilateral decompression outside-in approach: a proctorship guideline with 12 steps of effectiveness and safety.</a> Neurospine. 17 (Suppl 1), S99 (2020).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Kerrison Rongeur&#160;</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>The endoscopic high-speed&#160;diamond burr</td>
			<td>NSK-Nakanishi International, Co., Ltd., Osaka, Japan</td>
			<td>Primado P200-RA330</td>
			<td></td>
		</tr>
		<tr>
			<td>The endoscopic surgical system Delta</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>The radiofrequency probe</td>
			<td>Elliquence LLC, Baldwin, New York</td>
			<td>Trigger-FlexR Bipolar System</td>
			<td></td>
		</tr>
		<tr>
			<td>Trephine</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

percutaneous endoscopic unilateral-approach bilateral decompression for lumbar spinal stenosis

Read this Scientific Article Protocol about Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis at JoVE.com

<meta charset="utf8"></head><body>저자 스포트라이트: 요추 척추관 협착증 치료를 위한 안전하고 효과적이며 최소 침습적 접근법으로서의 LE-ULBD의 범위

요추 척추관 협착증에 대한 경피적 내시경 편측 접근법 양측 감압술

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ...

percutaneous-endoscopic-unilateral-approach-bilateral-decompression

Research

JoVE Journal

Medicine

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

317 조회수.  Minhang Hospital, Fudan University. 본 프로토콜은 양측 감압술(LE-ULBD)을 위한 요추 내시경 편측 층절개술의 단계와 요점을 설명합니다. 이 기술은 퇴행성 요추 척추관 협착증을 치료하는 데 사용됩니다. 가장 큰 장점은 LE-ULBD가 수술 관련 외상을 줄이면서 수술 부위에 대한 탁월한 선명한 시각화를 제공한다는 것입니다.내시경 척추 수술은 처음에 요추 추간판 탈출증에 사용되었?...

비디오: 저자 스포트라이트: 요추 척추관 협착증 치료를 위한 안전하고 효과적이며 최소 침습적 접근법으로서의 LE-ULBD의 범위

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.

요 추 간 요 추 디스크 Herniations 위한 내 시경의 모바일 외부에서 기술

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

연구

의학

Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally (3D) printed coronary implants can be employed to percutaneously create a focal coronary stenosis. However, reliable delivery of the implants can be difficult without the use of ancillary equipment. We describe the use of a mother-and-child coronary guide catheter for stabilization of the implant and for effective delivery of the 3D printed implant to any desired location along the length of the coronary vessel. The focal coronary narrowing was confirmed under coronary cineangiography and the functional significance of the coronary stenosis was assessed using gadolinium-enhanced first-pass cardiac perfusion MRI. We showed that reliable delivery of 3D printed coronary implants in swine models (n = 11) of ischemic heart disease can be achieved through repurposing mother-and-child coronary guide catheters. Our technique simplifies the percutaneous delivery of coronary implants to create closed-chest swine models of focal coronary artery stenosis and can be performed expeditiously, with a low procedural failure rate.

We describe a novel, cost-effective, and efficient technique for percutaneous delivery of three-dimensionally printed coronary implants to create closed-chest swine models of ischemic heart disease. The implants were fixed in place using a mother-and-child extension catheter with high success rate.

허혈성 심장 질환의 돼지 모델에 3D 인쇄 관상 동맥 협착 임플란트의 배포를위한 새로운 경피적 인 접근 방식

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally ...

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.

요추 추간판 탈출증 치료를 위한 전체 내시경 격리 구역 기술

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

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a traditional minimally invasive, thoracotomy-based approach. Exposure of the groin vessels for the establishment of cardiopulmonary bypass (CPB) via surgical cutdown in minimally invasive surgery (MIS) may result in wound healing disorders or seroma formation. The avoidance of surgical exposure of the groin vessels by using fully percutaneous techniques for the insertion of a CPB cannula with the implementation of vascular pre-closure devices has the potential to reduce these complications and improve clinical results. Herein, we present the utilization of a novel plug based vacsular closure device with a resobable collagen plug and the absence of suture material for closure of the arterial access for CPB in MIS. While this device was initially predominantly used in transcatheter aortic valve implantation (TAVI) procedures, with its safety and feasibility shown, we herein show that it can be used in CPB cannulation, since it is capable of closing arterial access sites up to 25 French (Fr.) in size. This device may be suitable to significantly reduce groin complications in MIS and simplify the establishment of CPB. Here, we describe the fundamental steps of EMS, including percutaneous groin cannulation and decannulation using a vascular closure device.

This protocol demonstrates in detail how to perform fully endoscopic mitral valve surgery (EMS) with percutaneous cannulation of the groin vessels, using a percutaneous plug-based vascular closure device. Fundamental steps and useful instructions are described in detail for each step.

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a ...

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.

현미경 보조 최소 침습 전방 요추 체간 유합술의 임상 적용

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

요추 협착증 및 반대측 탈출증을 위한 3채널 내시경 기법

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.

저자 스포트라이트: 척추 수술에서 TUBE 기법의 잠재력 공개

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.

반대측 추간판 탈출증과 결합된 요추 척추관 협착증에 대한 세 번째 채널 보조 편측 이중문맥 내시경 기법

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

요추 내시경 검사에서 고리 섬유증 복구를 위한 새로운 PLL-AF 봉합 기술

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

The suture technique for a ruptured annulus fibrosus (AF) under full-endoscopy remains challenging. Direct suturing of a ruptured annular tear after full decompression has been shown to decrease the recurrence rate of lumbar disc herniation during endoscopic surgery. Traditional suture operations under endoscopy involve only simple suturing of the ruptured AF. Due to the weak and poor quality of the AF tissue around the tear portal, using this area as needle insertion points during suturing may lead to insufficient tension and a low success rate of AF closure. Currently, there is no detailed technical illustration based on video for AF tear suturing under lumbar full-endoscopy. We innovatively propose a method of covering and suturing the AF tear by pulling up the posterior longitudinal ligament (PLL) under lumbar endoscopy and using three stitches (PLL-AF suture technique). The patient who received the novel suture technique achieved satisfactory results. Six months after the operation, lumbar MRI showed no evidence of recurrence in the outpatient clinic.

저자 스포트라이트: 경피적 경포경 내시경 추간판 절제술에서 환형 섬유증 수리를 위한 새로운 봉합 기술의 개발 및 적용

This protocol describes an innovative suture technique for ruptured annular fibrosus during percutaneous transforaminal endoscopic discectomy.

경피적 경추공 내시경 추간판 절제술에서 감압술 후 파열된 고리 섬유증을 위한 봉합 기술

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