Name: a mobile outside-in technique of transforaminal lumbar endoscopy for lumbar disc herniations
Uploaded: 2018-08-07T13:30:00
Description: Watch this Scientific Journal Video about A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations at JoVE.com

Vi vil gerne anerkende videnskabelige teammedlemmer Jae Eun Park og Kyeong-rae Kim for at give deres bistand i erhverve fuldtekst artikler og administration af digitale værker.

Protokollen følger retningslinjerne i Nanoori hospitals human videnskabsetisk Komité. Skriftligt informeret samtykke blev opnået fra alle patienter med unilateral nedre lemmer radiculopathy på grund af lumbal disk prolaps. Udelukkelseskriterierne var tilstedeværelsen af segmental ustabilitet, spondylolistese (mere end grade 1) og tilstedeværelsen af betydelige spinal stenose.
1. patienten holdning og huden mærkning
<ol><li>Placer patienten i liggende position på radiolucent operation...

<ol>
	<li>Tzaan, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transforaminal+percutaneous+endoscopic+lumbar+discectomy.">Transforaminal percutaneous endoscopic lumbar discectomy.</a> Chang Gung medical journal. 30 (3), 226 (2007).</li><li>Morgenstern, R., Morgenstern, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+Transforaminal+Lumbar+Interbody+Fusion+(pTLIF)+with+a+Posterolateral+Approach+for+the+Treatment+of+Degenerative+Disk+Disease:+Feasibility+and+Preliminary+Results.">Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results.</a> International journal of spine surgery. 9, (2015).</li><li>Ying, J., 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+effect+and+feasibility+study+of+transforaminal+percutaneous+endoscopic+lumbar+discectomy+via+superior+border+of+inferior+pedicle+approach+for+down-migrated+intracanal+disc+herniations.">The effect and feasibility study of transforaminal percutaneous endoscopic lumbar discectomy via superior border of inferior pedicle approach for down-migrated intracanal disc herniations.</a> Medicine. 95 (8), (2016).</li><li>Schubert, M., Hoogland, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+transforaminal+nucleotomy+with+foraminoplasty+for+lumbar+disk+herniation.">Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation.</a> Operative Orthopadie und Traumat.ologie. 17 (6), 641-661 (2005).</li><li>Telfeian, A. E., Jasper, G. P., Francisco, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transforaminal+endoscopic+treatment+of+lumbar+radiculopathy+after+instrumented+lumbar+spine+fusion.">Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion.</a> PainPhysician. 18 (2), 179-184 (2015).</li><li>Kim, H. S., 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=Analysis+of+clinical+results+of+three+different+routes+of+percutaneous+endoscopic+transforaminal+lumbar+discectomy+for+lumbar+herniated+disk.">Analysis of clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy for lumbar herniated disk.</a> Worldneurosurgery. 103, 442-448 (2017).</li><li>Gore, S., Yeung, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+&amp;#34;inside+out&amp;#34;+transforaminal+technique+to+treat+lumbar+spinal+pain+in+an+awake+and+aware+patient+under+local+anesthesia:+results+and+a+review+of+the+literature.">The &amp;#34;inside out&amp;#34; transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature.</a> International journal of spine surgery. 8, (2014).</li><li>Choi, G., Pophale, C. S., Patel, B., Uniyal, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+Spine+Surgery.">Endoscopic Spine Surgery.</a> Journal of Korean Neurosurgical Society. 60 (5), 485 (2017).</li><li>Hoogland, T., Schubert, M., Miklitz, B., Ramirez, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transforaminal+posterolateral+endoscopic+discectomy+with+or+without+the+combination+of+a+low-dose+chymopapain:+a+prospective+randomized+study+in+280+consecutive+cases.">Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases.</a> Spine. 31 (24), E890-E897 (2006).</li><li>Ruetten, S., Komp, M., Godolias, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+extreme+lateral+access+for+the+surgery+of+lumbar+disc+herniations+inside+the+spinal+canal+using+the+full-endoscopic+uniportal+transforaminal+approach-technique+and+prospective+results+of+463+patients.">An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients.</a> Spine. 30 (22), 2570-2578 (2005).</li><li>Johnson, E. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Visual analog scale (VAS). , (2001).</li><li>Fairbank, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oswestry+disability+index.">Oswestry disability index.</a> Journal of neurosurgery Spine. 20 (2), 239 (2014).</li><li>Macnab, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Negative+Disc+Exploration:+an+analysis+of+the+causes+of+nerve-root+involvement+in+sixty-eight+patients.">Negative Disc Exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients.</a> The Journal of bone and joint surgery. 53 (5), 891-903 (1971).</li><li>Hoogland, T., van den Brekel-Dijkstra, K., Schubert, M., Miklitz, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+transforaminal+discectomy+for+recurrent+lumbar+disc+herniation:+a+prospective,+cohort+evaluation+of+262+consecutive+cases.">Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases.</a> Spine. 33 (9), 973-978 (2008).</li><li>Yeung, A. T., Tsou, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Posterolateral+endoscopic+excision+for+lumbar+disc+herniation:+surgical+technique,+outcome,+and+complications+in+307+consecutive+cases.">Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases.</a> Spine. 27 (7), 722-731 (2002).</li><li>Kambin, P., Gellman, 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+Lateral+Discectomy+of+the+Lumbar+Spine+A+Preliminary+Report.">Percutaneous Lateral Discectomy of the Lumbar Spine A Preliminary Report.</a> Clinical Orthopaedics and Related Research. 174, 127-132 (1983).</li><li>Hoogland, T. <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+discectomy.">Percutaneous endoscopic discectomy.</a> Journal of neurosurgery. 79 (6), 967-968 (1993).</li><li>Knight, M., Goswami, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+isthmic+spondylolisthesis+with+posterolateral+endoscopic+foraminal+decompression.">Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression.</a> Spine. 28 (6), 573-581 (2003).</li><li>Pain, B., Telfeian, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+retrospective+evaluation+of+the+clinical+success+of+transforaminal+endoscopic+discectomy+with+foraminotomy+in+geriatric+patients.">A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients.</a> Painphysician. 16, 225-229 (2013).</li><li>Kim, H. S., Ju, C. I., Kim, S. W., Kim, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+transforaminal+suprapedicular+approach+in+high+grade+inferior+migrated+lumbar+disc+herniation.">Endoscopic transforaminal suprapedicular approach in high grade inferior migrated lumbar disc herniation.</a> Journal of Korean Neurosurgical Society. 45 (2), 67 (2009).</li><li>Chae, K. 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=Strategies+for+noncontained+lumbar+disc+herniation+by+an+endoscopic+approach:+transforaminal+suprapedicular+approach,+semi-rigid+flexible+curved+probe,+and+3-dimensional+reconstruction+CT+with+discogram.">Strategies for noncontained lumbar disc herniation by an endoscopic approach: transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction CT with discogram.</a> Journal of Korean Neurosurgical Society. 46 (4), 312 (2009).</li><li>Anichini, G., 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=Lumbar+endoscopic+microdiscectomy:+Where+are+we+now?+An+updated+literature+review+focused+on+clinical+outcome,+complications,+and+rate+of+recurrence.">Lumbar endoscopic microdiscectomy: Where are we now? An updated literature review focused on clinical outcome, complications, and rate of recurrence.</a> BioMed research international. , (2015).</li><li>Gotecha, S., 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+role+of+transforaminal+percutaneous+endoscopic+discectomy+in+lumbar+disc+herniations.">The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations.</a> Journal of craniovertebral junction &amp; spine. 7 (4), 217 (2016).</li><li>Ruetten, S., Komp, M., Merk, H., Godolias, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recurrent+lumbar+disc+herniation+after+conventional+discectomy:+a+prospective,+randomized+study+comparing+full-endoscopic+interlaminar+and+transforaminal+versus+microsurgical+revision.">Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision.</a> Clinical Spine Surgery. 22 (2), 122-129 (2009).</li><li>Weir, B., Jacobs, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reoperation+rate+following+lumbar+discectomy.+An+analysis+of+662+lumbar+discectomies.">Reoperation rate following lumbar discectomy. An analysis of 662 lumbar discectomies.</a> Spine. 5 (4), 366-370 (1980).</li><li>&#xD6;sterman, H., Sund, R., Seitsalo, S., Keskim&#228;ki, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+of+multiple+reoperations+after+lumbar+discectomy:+a+population-based+study.">Risk of multiple reoperations after lumbar discectomy: a population-based study.</a> Spine. 28 (6), 621-627 (2003).</li><li>Xin, G., Shi-Sheng, H., Hai-Long, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphometric+analysis+of+the+YESS+and+TESSYS+techniques+of+percutaneous+transforaminal+endoscopic+lumbar+discectomy.">Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy.</a> Clinical Anatomy. 26 (6), 728-734 (2013).</li><li>Pan, Z., Ha, Y., Yi, S., Cao, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+transforaminal+endoscopic+spine+system+(TESSYS)+technique+in+treating+lumbar+disc+herniation.">Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation.</a> Medical science monitor: international medical journal of experimental and clinical research. 22, 530 (2016).</li></ol>

Undersøgelsen er baseret på en prospektiv analyse af 184 patienter med lumbal disk sygdom, der blev forvaltet på vores Institut. X-ray imaging, beregnet tomografi (CT) og magnetisk resonans imaging (MR) blev gjort i alle tilfælde at bekræfte diagnosen og at udelukke andre patologier. Resultaterne viste på CT og Mr scanninger var korreleret med en neurologisk undersøgelse. Efter den rette diagnose, blev patienter opereret med mobile udenfor-i teknikken med PETLD. Udelukkelseskriterierne var tilstedeværelsen af seg...

fChronic lændesmerter og smerter i benene er fælles lidelser i ethvert samfund. Behandlingsmodaliteter degenerativ lumbal disk sygdomme har været under konstant udvikling. Angrebsformål har været bredt, fra åben kirurgi og fiksering til microlumbar discectomy, og nu endoskopisk rute1,2,3,4. Den transforaminal vej, oprindeligt foreslået af Parvez Kambin, nu efterhånden en standard for pleje5,6,7. Fordelene ved fuld-endoskopisk rygsøjlen kirurgi er mindre bløde væv dissektion, mindre blodtab, reduceret hospital optagelse dage, en tidlig funktionel genopretning og en forbedring i livskvalitet8.
Den traditionelle udenfor-i tilgang af PETLD, givet af Schubert og Hoogland4, omhandler indførelsen af en arbejdende kanyle i foramen og derefter en udvidelse af foramen ved hjælp af reamers. Rationalet bag metoden udenfor-i roman teknik er nævnt her er at det ikke udelukkende afhænger af udvide foramen i alle tilfælde. Teknikken, der fokuserer på den præcise placering af arbejdende kanylen i foramen og derefter vejlede bevægelse af kanylen mod målet-fragment under endoskopisk vision9,10. Anatomisk, der er tre forskellige ruter i transforaminal rum, og hvis de anvendes effektivt, perkutan endoskopisk rygsøjlen kirurgi med udenfor-i-teknik kan anvendes til en bredere vifte af lændestøtte discusprolaps. Central, paracentral og høj canal kompromitteret mælkesyre Dehydrogenase (LDH) er kontaktet af intervertebrale ruten; foraminal, overlegent overflyttede og langt laterale LDH er kontaktet af det foraminal rute, og inferiorly overflyttede LDH er kontaktet af suprapedicular rute6. Fordelen ved denne teknik er, at det bevarer de normale anatomiske strukturer med mindre discal skade, epidural eksponering er let, og manipulation af en arbejdende kanyle i foramen er ikke svært. Den teknik beskrevet adskiller sig fra den tidligere, fordi det giver en præcis vision af strukturer inden for foramen og fokuserer på den nøjagtige placering af kanylen i foramen og ikke på udvidelse af foramen. Teknikken er lige så sikkert som inside-out teknik og giver en nem håndtering af strukturer, især de ekstruderet fragmenter. Målet med denne undersøgelse er at bevise alsidigheden af denne nye fremgangsmåde i forvaltningen af forskellige typer af disk prolaps som central, paracentral, foraminal, langt lateral og op og ned migration, og i high-kanalen kompromis tilfælde. Teknik, men kræver et længere indlæringskurve og begyndere skal derfor være patienten mens læring.

<table border="0" cellpadding="0" cellspacing="0" width="651">
	<tbody>
		<tr height="20">
			<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

Perkutan endoskopisk transforaminal lumbal discectomy (PETLD) er nu blevet en standard for pleje for forvaltningen af lumbal disk sygdom. Der er to teknikker til indførelse af en arbejdende kanyle med hensyn til disk – udefra og indefra og ud. Formålet med denne prospektive undersøgelse er at beskrive de tekniske aspekter af en roman mobile udenfor-i metode beskæftiger sig med forskellige typer af disk prolaps. I alt 184 træk patienter med unilateral nedre lemmer radiculopathy på grund af lumbal disk prolaps blev opereret med mobile udenfor-i teknikken med PETLD. Deres kliniske resultater blev evalueret baseret på typen disc prolaps de havde, en visuel analog skala (VAS) ben smerte score, Oswestry handicap Index (ODI) og Macnab kriterier. Fuldstændigheden af dekompression blev dokumenteret med en postoperativ magnetisk resonans billeddannelse. Gennemsnitsalderen for patienterne var 50 ± 16 år og mand/kvinde-forholdet 2:1. Den gennemsnitlige opfølgning blev 19 ± 6 måneder. I alt 190 lumbale niveauer blev opereret (L1-L2: n = 4, L2-L3: n = 17, L3-L4: n = 27, L4-5: n = 123 og L5-S1: n = 19). Opdelt i typer, patient fordelingen var centrale: n = 14, paracentral: n = 74, foraminal: n = 28, langt laterale: n = 13, superior-overflyttet: n = 8, ringere overflyttet: n = 38 og høj canal kompromis: n = 9. Den gennemsnitlige udløsende gang var 35 ± 12 (25-56) min og den gennemsnitlige sygehusophold var 1,2 ± 0,5 (1-3) dage. VAS-score for smerter i benene forbedret fra 7,5 ± 1 til 1,7 ± 0,9. ODI forbedret fra 70 ± 8.3 til 23 ± 5. 75 patienter (40.8%) havde fremragende resultater kriterier Macnab 104 patienter (56,5%) havde gode resultater, og 5 patienter (2,7%) havde fair resultater. Gentagelse (herunder tidlig og sen) sås i 15 ud af de 190 niveauer, der blev opereret (7.89%). Denne artikel præsenterer en roman udenfor-i-tilgang, der bygger på en præcis landing i foramen på en mobil måde og ikke udelukkende afhænger af med udvidelsen af foramen. Det er mere alsidig i ansøgningen og nyttige i ledelse af alle typer af disk prolaps, selv i svære canal kompromis og høj migration.

Resultatet evaluering:
Resultatet af operationen blev målt af VAS ben smerte score11, ODI12og Macnab kriterier13. Disse blev målt i den præoperative periode og under opfølgende besøg (1 uge efter operationen, 3 måneder efter operationen, og på den sidste opfølgning).
<stron...

Watch this Scientific Journal Video about A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations at JoVE.com

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

En mobil udenfor-i teknik af Transforaminal lænden endoskopi for lumbal Disc Herniations

Her præsenterer vi en protokol af en roman udenfor-i teknik af transforaminal endoskopisk discectomy for lumbal disc herniations. De tekniske aspekter af teknikken, bred angivelser af brug og resultaterne af behandlingen i 184 patienter er beskrevet i detaljer.

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

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

Laparoskopi-endoskopi Kooperativ kirurgi til behandling af gastriske gastrointestinale stromal tumorer

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 ...