심영보(Shim Young-Bo) - 성베드로병원 신경외과
이녹영(Lee Nok-Young) - 성베드로병원 신경외과
허승호(Huh Seung-Ho) - 성베드로병원 신경외과
하상수(Ha Sang-Soo) - 성베드로병원 신경외과
윤강준(Yoon Kang-Jun) - 성베드로병원 신경외과
Abstract
Objective: So called "minimally invasive procedures" have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indications in the thoracolumbar spine.
Methods: The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and 25°viewing angle was used. The mean follow up period was 6 months (range, 3-9).
Results: Operated levels were from T12-L1 disc down to L5-L6 or S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab’s criteria was used to assess the outcome. Favorable outcome, excellent or good, was seen in 78% (57 procedures) of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other.
Conclusion: Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the rate of standard open microsurgery.
키워드
Endoscopic, Transforaminal, Herniated discs, Indications, Outcome
KMID :
1001920070410040241
원문 및 링크아웃 정보
등재저널 정보
유효성결과(Recomendation)
endoscopic lumbar surgery approaches reported favorable outcome with mid-range in patients with disc herniation from T12-L1 disc down to L5-L6 or S1 disc.