Name: transtubular endoscopic posterolateral decompression for l5-s1 lumbar lateral disc herniation
Uploaded: 2022-10-14T13:00:00
Description: Watch this Scientific Journal Video about Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation at JoVE.com

这项研究得到了冈山脊柱小组的支持。

本研究获得冈山玫瑰医院伦理委员会（第305号）的批准。
1. 患者病史采集
<ol><li>确保患者有导致严重坐骨神经痛的椎间盘突出。通常，患者会有一些前驱性腰痛的病史。他们可能将他们的症状与创伤发作联系起来。</li>
	<li>要求患者描述他们的放射性腿部疼痛，包括其位置。还要向他们询问当怀疑LFS或LLDH时使其更好或更糟的活动。</li>
</ol><strong...

<ol>
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L5神经根症状主要由L4-L5椎间盘突出或狭窄引起。这些症状也可能由 L5 腰椎间孔狭窄或 L5-S1 外侧腰椎间盘突出症 （LLDH）9 引起。在所有有症状的腰椎间盘突出症中，L5-S1 FLDH 约占 3%10。对于 L5-S1 椎间孔病变，建议采用后外侧或经椎间孔入路。对于这种方法，有三种主要技术，例如显微镜，内窥镜管和全内窥镜方法。1997年，Foley推出了带有管的微内窥镜腰椎间盘?...

L5-S1级别的腰椎间孔狭窄（LFS）和腰椎间盘突出症（LLDH）的诊断和手术对于脊柱外科医生来说是具有挑战性的，因为该水平的独特结构1。髂嵴、宽L5横突（TP）、骶骨和L5 TP之间的小空间以及骨赘使手术窗口非常狭窄2.如果骨切除术不够，L5神经根减压不足可能导致残留症状。大量切除骨会导致术后不稳定。这些问题限制了外科医生进行椎间孔/椎间孔外 L5 根部减压的能力。一些报告显示，微创脊柱手术具有良好的效果，例如该区域的显微镜或内窥镜手术，以减压L5神经根3，4。最近，已有报道使用导航进行L5根的椎间孔减压，手术结果良好5。
全内镜下椎间盘切除术正成为切除外侧腰椎间盘突出症的流行方法 6.此外，微内窥镜手术与导航相结合可以帮助外科医生以2的精度减压L5根。通常，这些技术需要在术中使用C型臂。这种方法的目标是在没有C型臂的情况下，以最小的骨切除精确地减压L5根。
该技术的适应症是椎间孔外腰椎间盘突出和椎间孔腰椎间盘外侧半部的脑疝/狭窄。禁忌证是椎间孔腰椎间盘内侧三分之一的脑疝/狭窄，因为范围无法到达目标区域2。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1488 HD 3-Chip camera system</td>
			<td>Stryker</td>
			<td>1000902487</td>
			<td></td>
		</tr>
		<tr>
			<td>16mm Endoscope Attachment, Sterile</td>
			<td>Medtronic</td>
			<td>9560160</td>
			<td></td>
		</tr>
		<tr>
			<td>18mm Endoscope Attachment, Sterile</td>
			<td>Medtronic</td>
			<td>9560180</td>
			<td></td>
		</tr>
		<tr>
			<td>4K 32&#34; surgical display</td>
			<td>Stryker</td>
			<td>0240-031-050</td>
			<td></td>
		</tr>
		<tr>
			<td>Adjustable hinged operating carbon table</td>
			<td>Mizuho OSI</td>
			<td>6988A-PV-ACP</td>
			<td>OSI Axis Jackson table</td>
		</tr>
		<tr>
			<td>L10 AIM light source</td>
			<td>Stryker</td>
			<td>1000902487</td>
			<td></td>
		</tr>
		<tr>
			<td>METRx MED System Endoscope, Long</td>
			<td>Medtronic</td>
			<td>9560102</td>
			<td></td>
		</tr>
		<tr>
			<td>METRx MED System Reusable Endoscope</td>
			<td>Medtronic</td>
			<td>9560101</td>
			<td>Metrx</td>
		</tr>
		<tr>
			<td>METRx MED System Reusable Endoscope</td>
			<td>Medtronic</td>
			<td>9560101 M</td>
			<td></td>
		</tr>
		<tr>
			<td>METRx MED System Reusable Endoscope, Long</td>
			<td>Medtronic</td>
			<td>9560102</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated high speed bur</td>
			<td>Medtronic</td>
			<td>EM200N</td>
			<td>Stelth&#160;</td>
		</tr>
		<tr>
			<td>Navigated passive pointer</td>
			<td>Medtronic</td>
			<td>960-559</td>
			<td></td>
		</tr>
		<tr>
			<td>NIM Eclipse system</td>
			<td>Medtronic</td>
			<td>ECLC</td>
			<td>Neuromonitouring</td>
		</tr>
		<tr>
			<td>O-arm</td>
			<td>Medtronic</td>
			<td>224ABBZX00042000</td>
			<td>Intraoperative CT</td>
		</tr>
		<tr>
			<td>Stealth station navigation system Spine 7R</td>
			<td>Medtronic</td>
			<td>9733990</td>
			<td>Navigation</td>
		</tr>
		<tr>
			<td>Surgical Carts</td>
			<td>Stryker</td>
			<td>F-NSK-006-00</td>
			<td></td>
		</tr>
		<tr>
			<td>Tubular Retractor, 16mm</td>
			<td>Medtronic</td>
			<td>955-524</td>
			<td></td>
		</tr>
		<tr>
			<td>Tubular Retractor, 16mm, Long</td>
			<td>Medtronic</td>
			<td>9560216</td>
			<td></td>
		</tr>
		<tr>
			<td>Tubular Retractor, 18mm</td>
			<td>Medtronic</td>
			<td>9560118</td>
			<td></td>
		</tr>
		<tr>
			<td>Tubular Retractor, 18mm, Long</td>
			<td>Medtronic</td>
			<td>9560218</td>
			<td></td>
		</tr>
	</tbody>
</table>

transtubular endoscopic posterolateral decompression for l5-s1 lumbar lateral disc herniation

我们报道了一种在基于CT的导航下进行C型臂游离管L5神经减压的新技术，以减少辐射危害。该过程在全身麻醉和神经监测下进行。将患者置于手术碳工作台上的俯卧位。将导航参考系经皮放置在对侧骶髂关节或棘突中。然后，获得CT扫描图像。仪器注册后，使用导航探头确认L5-S1椎间孔水平，并标记入口点。使用约2厘米的皮肤切口，解剖皮下组织和肌肉。导航的第一个扩张器瞄准L5-S1坎宾三角形，并进行顺序扩张。使用18 mm管并将其固定在框架上。坎宾三角形周围的骨头被导航毛刺移除。对于外侧椎间盘突出症，识别L5神经根并缩回，并切除椎间盘碎片。导航引导的管状内镜减压是一种有效的方法。对外科医生或手术室工作人员没有辐射危害。

八例（四名男性，四名女性）使用这种新技术接受了手术。平均年龄72.0岁，平均随访期1.5岁。L5/S1椎间孔狭窄患者5例，L5/S椎间孔盘突出2例，L3/4椎间孔盘突出1例。我们可以在没有C型臂的情况下进行所有手术。平均手术时间和失血量分别为143 min±14 min和134±18 mL。
使用日本骨科协会（JOA）评分（背痛评估）8 获得的平均恢复百分比为72.3%（57%-88%）。腿部疼痛?...

Watch this Scientific Journal Video about Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation at JoVE.com

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

这里介绍的是一种在O臂导航下无C型臂经管后外侧减压治疗腰椎间孔狭窄和外侧椎间盘突出症的新技术。

经管内镜后外侧减压治疗L5-S1腰椎外侧椎间盘突出症

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

L5-S1水平腰椎间孔狭窄和腰椎外侧盘突出症的诊断和手术因其独特的结构而对脊柱外科医生具有挑战性。髂嵴在L5横突以下，骶鼻翼与L5横突间隙小，骨赘使手术窗口很窄。如果骨切除不够，L5神经根减压不足使残留症状。大量骨切除会导致术后不稳定。这些原因限制了外科医生对椎间孔外L5根减压术的熟悉程度。一些报告支持微创脊柱手术的良好结果，例如该区域的显微或内窥镜手术以减压L5神经根。最近，使用导航对L5神经根进行椎间孔减压已有报道，并取得了良好的手术效果。真正的内窥镜椎间盘切除术在去除自然椎间盘突出症方面越来越受欢迎。此外，显微内窥镜手术与导航相结合，可以帮助外科医生精确地减压L5神经根。通常，这些技术需要在术中使用 C 臂。这种方法的目标是精确地减压L5根，无需C型臂即可进行最小的骨切除。这项研究得到了冈山罗赛医院伦理委员会的批准。这是经管内镜下后外侧减压治疗 L5-S1 腰椎间盘突出症的方案。评估射线照相和磁共振成像。站立位进行前、后和侧位 X 线检查，以检查腰椎畸形和脊椎滑脱。如果患者有严重畸形，则需要进行脊柱融合术。以站立姿势进行功能性射线照相。检查功能性X线照片，通过测量椎体异常运动来确认腰椎不稳。进行 MRI 以准确评估腰椎间盘突出症，显示发生腰椎间盘突出的位置以及受影响的神经。对于腰椎间盘外侧突出症，取冠状 T2 加权图像以确定椎间盘突出的位置。CT 和 MRI-CT 融合图像的评估。CT 对于检查椎间盘突出是否钙化或消除被骨赘压迫的神经很重要。MRI-CT融合图像对于了解椎间盘突出的确切3D位置非常有用。患者体位和神经监测。为患者提供全身麻醉。确保患者的眼睛没有被特殊的面罩压迫。注意垫位不要压迫患者的腹部。神经监测是这种技术的首选。我们的系统是一个多模态的术中运动系统，用于访问脊髓完整性并对关键神经通路提供警告潜在危害。术中CT和脊柱导航。这种计算机控制的柔性全碳框架非常有用。通过电缆将CT 3D重建图像自动传输到导航系统。导航仪器注册。通过手动点击不同框架的尖端来注册导航的指针导向器和高速毛刺。切口和肌肉解剖。在导航指针的帮助下，确认 L5-S1 孔水平的位置。做一个大约2厘米的纵向皮肤切口。然后沿肌纤维解剖皮下组织、腰髂肋肌和多裂肌。医生使用导航在L5横向过程的底部导航快速导向器。然后插入顺序扩张器。插入最后一根管并将其固定在框架上。将最后一根管固定到柔性臂组件主管上。骨切除术，带导航高速毛刺。使用导航监视器中的导航指针检查 L5-S1 级别。用导航的高速毛刺去除横突底部的骨头和小关节的外侧部分。内镜下椎间盘切除术。识别 L5 神经根并通过神经牵开器颅骨回缩。然后小心地用垂体钳取出椎间盘碎片。这些是术后CT和MRI。椎间盘突出和骨赘被完全切除。具有代表性的结果。这种新技术有八例，四男四女。平均年龄为72岁，平均随访期为1.5年。平均手术时间和失血量分别为143分钟和134毫升。日本协会评分的平均恢复率为72.3%。没有手术并发症。总之，我们的新技术导航减压对自然L5-S1病变非常有用。O型臂导航为外科医生提供3D图像指导，并有助于骨元素的准确发育。最小的小关节切除术避免了额外的术后脊柱不稳定，特别是使用导航毛刺，有助于骨刺切除过程中的实时动态反馈。感谢您的关注。

Research

JoVE Journal

Neuroscience

Lateral Fluid Percussion: Model of Traumatic Brain Injury in Mice

侧向液压冲击：创伤性脑损伤小鼠模型

Traumatic brain injury (TBI) research has attained renewed momentum due to the increasing awareness of head injuries, which result in morbidity and ...

科研

神经科学

Lateral Diffusion and Exocytosis of Membrane Proteins in Cultured Neurons Assessed using Fluorescence Recovery and Fluorescence-loss Photobleaching

横向扩散和培养的神经元膜蛋白的胞吐评估使用荧光恢复和荧光损失漂白

Membrane proteins such as receptors and ion channels undergo active trafficking in neurons, which are highly polarised and morphologically complex. This ...

A Large Lateral Craniotomy Procedure for Mesoscale Wide-field Optical Imaging of Brain Activity

大脑侧向颅骨切开术大脑活动的中尺度广角光学成像

The craniotomy is a commonly performed procedure to expose the brain for in vivo experiments. In mouse research, most labs utilize a small craniotomy, ...

Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice

Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice

横向慢性颅窗口准备启用<em&gt;在体内</em&gt;观察继末节小鼠大脑中动脉闭塞

Focal cerebral ischemia (i.e., ischemic stroke) may cause major brain injury, leading to a severe loss of neuronal function and consequently to a host of ...

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

内镜下鼻跨蝶入路: 垂体腺瘤的微创手术

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary ...

Laminotomy for Lumbar Dorsal Root Ganglion Access and Injection in Swine

Laminotomy 对猪腰背根神经节通路和注射的治疗

Dorsal root ganglia (DRG) are anatomically well defined structures that contain all primary sensory neurons below the head. This fact makes DRG attractive ...

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

微创内窥镜内腹出血疏散

Intracerebral hemorrhage (ICH) is a subtype of stroke with high mortality and poor functional outcomes, largely because there are no evidence-based ...

In Vivo Calcium Imaging of Lateral-line Hair Cells in Larval Zebrafish

幼虫斑马鱼外系头发细胞的活体钙成像

Sensory hair cells are mechanoreceptors found in the inner ear that are required for hearing and balance. Hair cells are activated in response to sensory ...

Use of Capillary Electrophoresis Immunoassay to Search for Potential Biomarkers of Amyotrophic Lateral Sclerosis in Human Platelets

使用毛细血管电泳免疫测定来寻找人类血小板肌萎缩性侧索硬化的潜在生物标志物

Capillary electrophoresis immunoassay (CEI), also known as capillary western technology, is becoming a method of choice for screening disease relevant ...

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

扩散MRI造影术在内窥镜内窥镜颅骨基础外科中的作用

Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of ...