頸椎間盤突出的雙通道脊柱內鏡手術技術要點和初步報告
Abstract：
Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This singlecentered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, "excellent," "good," and "fair" results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.
摘 要：
雙通道脊柱內鏡手術(BESS)治療頸椎間盤突出(CDH)少有報道。這篇文章的目的是描述一種新的BESS雙通道脊柱內鏡技術作為頸椎椎間盤突出的后入路，并報告初步結果和并發癥。這一單點入組的回顧性圖表回顧包括了109例因癥狀性單水平CDH而接受BESS的患者。在目標椎間盤水平的每個單側椎旁區域建立工作和觀察入口。內鏡探查允許通過安全進入內側孔進行有效的微創減壓，并進行最小椎板切除術和關節突切除術。在術后4、8、12和24周評估臨床結果，包括視覺模擬評分、頸部殘疾指數、Macnab標準和患者手臂的運動功能。術后24周，視覺模擬評分和頸部殘疾指數顯著改善(P <. 01)。根據Macnab標準，“優秀”、“良好”和“一般”的結果分別為55.9%、30.3%和13.8%。24周后受累上肢強度等級分布較初始值有顯著改善(P = 0.02)。1例患者因過度沖洗4周后出現運動無力，且程度下降。BESS后入路是治療頸椎間盤突出癥有效可行的方法。
Abbreviations:
ACDF = anterior cervical discectomy and fusion,
BESS = biportal endoscopic spine surgery,
CDH = cervical disk herniation,
NDI = neck disability index,
MRC = Medical Research Council,
MRI = magnetic resonance imaging,
VAS = visual analog scale.
