The Korean Journal of Pain

  • 제18권1호
  • /
  • Pages.34-38
  • /
  • 2005
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지

요추 추간판 탈출증에 대한 경피적 내시경 레이저 수핵 제거술 후 임상 결과

Clinical Outcomes of Percutaneous Endoscopic Laser Lumbar Discectomy

  • 장원석 (우리들병원 미세진단치료센터) ;
  • 이상호 (우리들병원 미세진단치료센터)
  • Chang, Won Sok (Department of Microdiagnostic Therapy Center, Wooridul Spine Hospital) ;
  • Lee, Sang Ho (Department of Microdiagnostic Therapy Center, Wooridul Spine Hospital)
  • 투고 : 2005.03.29
  • 심사 : 2005.05.26
  • 발행 : 2005.06.30
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초록

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

키워드

참고문헌

  1. Nygaard OP, Mellgren SI, Osterud B: The inflammarory properties of contained and noncontained lumbar disc herniation. Spine 1997;22: 2484-8. https://doi.org/10.1097/00007632-199711010-00004
  2. Choy DS, Altman PA, Case RB, Trokel S1: Laser radiation at various wavelengths for decompression of intervertebral disck - Experiemnral observations on human auropsy speciarnens, Clin Orthop Relar Res 1991; 267: 245-50.
  3. Choy DS, Ascher PW, Ranu HS, Saddekni S, Alkaitis D, Liebler W, et al: Percutaneous laser disc decompression. A new therapeutic modality. Spine 1992; 17: 949-56. https://doi.org/10.1097/00007632-199208000-00014
  4. Tsou PM, Yeung AT: Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J 2002; 2: 41-8.
  5. Yeung AT, Tsou PM: Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27: 722-31. https://doi.org/10.1097/00007632-200204010-00009
  6. MacNab I: Negative disc exploration. An analysis of the causes of nerve root involvement in sixty-eight patients. J Bone Joint Surg Am 1971; 53: 891-903. https://doi.org/10.2106/00004623-197153050-00004
  7. Srolke D, Sollmann WP, Seifert V: Intra- and postoperative complications in lumbar disc surgery. Spine 1989; 14: 56-9. https://doi.org/10.1097/00007632-198901000-00011
  8. Davis JK: Early experience with laser disc decompression. J Fla Med Assoc 1992; 79: 37-9.
  9. Casper GD, Hartman VL, Mullins LL: Percutaneous laser disc decompression with the holmium-YAG laser. J Clin Laser Med Surg 1995; 13: 195-203.
  10. Smith L, Garvin PJ, Gesler RM, Jennings RB: Enzymatic dissolution of the nucleus pulposus. Narure 1963; 198: 1311-2.
  11. Hijikata S, Yamagishi M, Nakayma T: Percutaneous nucleoromy: a new treatment method for lumbar disc herniation. J Toden Hosp 1975; 5: 5-13.
  12. Kambin P, Sampson S: Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Clin Orthop Relat Res 1986; 207: 37-43.
  13. Choy DS, Case RB, Fielding W, Hughes J, Liebler W, Ascher P: Percutaneous laser nucleolysis of lumbar disks. N Engl J Med 1987;317: 771-2. https://doi.org/10.1056/NEJM198709173171217
  14. Karnbin P, O'Brien E, Zhou L, Schaffer J1: Arthroscopic microdiscecromy and selective fragmentecromy. Clin Orthop Relat Res 1998;347: 150-67.
  15. Ahn Y, Lee SH, Park WM, Lee HY: Posterolateral percutaneous endoscopic lumbar foraminotomy for L5- S1 foramina] or lateral exit zone stenosis. Technical note. J Neurosurg Spine 2003; 99: 320-3. https://doi.org/10.3171/spi.2003.99.3.0320
  16. Dirsworth DA: Endoscopic transforaminal lumbar discecromy and econfiguration: a postero-Iateral approach into the spinal canal. Surg Neurol 1998; 49: 588-97. https://doi.org/10.1016/S0090-3019(98)00004-4
  17. Kim WO, Yoon DM, Jang WS, Oh KM, Kim HE: Percutaneous laser discecromy in lumbar disc herniation. Korean J Pain 2001; 14:234-8.
  18. Kim WO, Yoon DM, Kil HK, Kim KW: Percutaneous Laser Disc Decompression (PLDD): one and half years experience. Korean J Pain 2003; 16: 42-7.
  19. Tassi GP: Preliminarhy Italian experience of lumbar spine percutaneous laser disc decompression according ro Choy's method. Phoromed Laser Surg 2004; 22: 439-41. https://doi.org/10.1089/pho.2004.22.439
  20. Gangi A, Dieternann JL, Ide C, Brunner P, Kinkert A, Warter JM: Percutaenous laser disk decompression under CT and fluoroscopic guidance: indications, technique, and clinical experience. Radiographies1996; 16: 89-96. https://doi.org/10.1148/radiographics.16.1.89
  21. Estridge MN, Johnson NG, Rouhe SA: The femoral stretching test. A valuable sign in diagnosing upper lumbar disc herniations. J Neurosurg 1982; 57: 813-7. https://doi.org/10.3171/jns.1982.57.6.0813