Technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc herniations in thoracolumbar junction
10.3969/j.issn.1004-406X.2024.04.05
- VernacularTitle:经椎间孔入路全内镜下椎体间融合术治疗胸腰段硬性椎间盘突出症的技术要点及临床疗效
- Author:
Zhenzhou LI
1
;
Zheng CAO
;
Hongliang ZHAO
Author Information
1. 解放军总医院第四医学中心骨科医学部 100048 北京市
- Keywords:
Intervertebral disc herniation;
Full-endoscopic interbody fusion;
Discectomy;
Transforaminal ap-proach
- From:
Chinese Journal of Spine and Spinal Cord
2024;34(4):362-371
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To study the technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc hemiations in thoracolumbar junction.Methods:14 patients with disc herniations involving 20 segments of hard disc hemiations in thoracolumbar junction treated with full-en-doscopic interbody fusion via transforaminal approach between January 2018 and September 2021 were includ-ed in the study.There were 11 males and 3 females with an average age of 43.3±12.6 years;3-segment dis-ease in 2 cases,2-segment disease in 2 cases,and single segment disease in 10 cases.The hard compres-sion were classified as:3 cases of calcified disc hemiation,6 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc,3 cases of disc hemiations with atypical Scheuer-mann disease and 2 cases of disc herniation with epiphyseal separation.All patients had symptoms of myelopathy or cauda equina compromise before operation,and 6 of them had radiculopathy.Via transforaminal approach under local anesthesia,full-endoscopic interbody fusion and discectomy were performed firstly,fol lowed with percutaneous pedicle screw system placement and fixation under general anesthesia.Postoperative imaging changes,pain symptoms and recovery of neurological function at 1 week,3 months,6 months and 1 year after operation were observed.Back pain and radicular pain were scored with visual analogue scale(VAS),neurological function was assessed with Nurick score and modified Japanese Orthopaedic Association(mJOA)score,and thoracic spine function was assessed with Oswestry disability index(ODI).Results:All operations were successfully completed,and no intraoperative conversion of surgical methods occurred.Postoperative tho-racolumbar junction MRI and CT examinations of all patients showed that the spinal cord or cauda equina was sufficiently decompressed without any residual compression.At 1 year follow-up,all surgical segments were fused.Back pain and radicular pain were all relieved significantly in all the patients,and neurological function was significantly restored.The Nurick score,mJOA score and ODI all improved compared with the preoperative values(P＜0.01),and the postoperative 1 year values all improved significantly compared with the values at postoperative 1 week,3 months and 6 months(P＜0.01).The average recovery rate of mJOA was 72.5％,with 7 cases excellent,5 cases good and 2 cases fair.Dural tear occurred in 2 cases during opera-tion,but no cerebrospinal fluid leakage and pseudomeningocele occurred during follow-up.No other surgical complications occurred.Conclusions:Full-endoscopic interbody fusion and resection of herniated hard disc vi-a transforaminal approach under local anesthesia followed with percutaneous pedicle screw system fixation un-der general anesthesia are safe and effective minimally invasive spine surgery for the treatment of hard disc herniation located in the thoracolumbar junction.
