椎旁入路单侧双通道内镜治疗胸椎间盘突出骨化

Unilateral biportal endoscopic discectomy by paravertebral approach for thoracic ossified intervertebral disc herniation

摘要:

[目的] 介绍椎旁入路单侧双通道内镜治疗胸椎间盘突出骨化的手术技术和初步临床效果。[方法] 建立单侧双通道，持续生理盐水冲洗，在可视镜头下找到T₁₂关节突尖部，打磨扩大处理对应椎间孔区。经椎间孔向椎管内逐渐扩大，显露增生骨化的病变组织。上下以T₁₁椎弓根下缘及T₁₂椎弓根上缘为界，内外以椎间孔到黄韧带左右中点为界，使用带保护套的磨钻从外侧下方去除硬膜腹侧突出硬化的部分髓核组织。压迫解除后置入引流管缝合包扎。[结果] 术中成功切除压迫脊髓的骨化椎间盘及增生的黄韧带，术后第2 d引流量20 mL，拔除引流管，腰椎CT、MRI提示T_11/12节段突出的髓核组织已被摘除，神经根及硬膜囊受压明显改善。术后第3 d患者诉双下肢疼痛无力明显好转，VAS评分4分，神经运动功能提升。[结论] 经椎旁入路单侧双通道脊柱内镜技术极大地克服了胸椎解剖结构狭窄的操作盲区，避开了椎管内的复杂神经根分布，减少了对脊髓的牵拉风险，并且实现了全方位的脊髓减压。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of unilateral biportal endoscopic discectomy for thoracic ossified intervertebral disc protrusion through the paravertebral approach. [Method] As portals for unilateral biportal endoscopy was established with continuous normal saline irrigation, the T₁₂ facet tip was identified under the endoscope and the corresponding intervertebral foramen area was burred and expanded to expose the ossified lesion gradually from the intervertebral foramen to the spinal canal. With the up-low boundary of the lower edge of the T₁₁ pedicle and the upper edge of the T₁₂ pedicle, and the in-out boundary of the midpoint of the intervertebral foramen to the left and right ligamentum flavum, the protruded and ossified nucleus pulposus was removed by a burr with protective sheath inferolateral to the dura mater. After proper compression achieved, a drainage tube was placed and the incisions were sutured and bandaged. [Results] During the operation, the ossified intervertebral disc compressing the spinal cord and the hyperplastic ligamentum flavum were successfully removed. On the second day after the operation, the drainage volume was of 20 mL and the drainage tube was removed. The postoperative lumbar CT and MRI showed that the protruded and ossified nucleus pulposus tissue in the T₁₁~T₁₂ segment had been properly removed, and the compression of the nerve root and the dural sac was significantly relieved. Three days after the operation, the patient reported significant improvement in bilateral lower limb pain and weakness, with VAS score of 4 and remarkably improved neurological motor function. [Conclusion] The unilateral biportal endoscopic technique through the paravertebral approach greatly overcomes the operational blind area caused by the narrow thoracic spine anatomy, avoids the complex nerve root distribution in the spinal canal, reduces the risk of traction on the spinal cord, and achieves comprehensive spinal decompression.