徐少克
童綜合醫院 骨科部
Endoscopic spinal surgery, at a crossroads similar to that of arthroscopic knee surgery in the 1970s, is poised to serve the same role. Percutaneous endoscopic discectomy techniques in spine surgery have evolved rapidly in the past several years. It was first introduced in the United States by Kambin et al in 1973 and the working triangle of nerve root was described and illustrated by Kambin in 1991.
Improvements in scope design, access cannulas, instrumentation, and adjunctive therapy now allow for a wider spectrum of endoscopic procedures that include routine spinal probing, tissue resection, tissue modulation, and ablation. These advancements have enhanced the surgeon’s ability to diagnose and treat discogenic pain and take on the full spectrum of disc herniations , including extruded and sequestered fragments.
The posterolateral endscopic discectomy technique was recognized as potentially even less invasive compared with the more familiar microscope-assisted transcanal approach. The satisfactory rate increase up to 90% since 2002 and can get the same result as standard discectomy procedure. The advantages of PELD are less trauma, rapid recover, less risk, less complications. In a contained herniated disc,
intradiscal surgery minimizes the incidence of recurrent herniation by protection of partially intact posterior annular fibers and posterior longitudinal ligament. Percutanenous endoscopic surgery with Interlaminal and extra-lateral approach can deal with L5S1 and sequestered discs and foraminal trap these are difficult deal with standard posterolateral approach. The indications of PELD now is more extend including contained, noncontained, recurrent, and far lateral discs, infective spondylodiscitis, lateral stenosis, discogenic pain and disc fusion.
In the future percutaneous endoscopic surgery will only be a small part of the surgical process that will incorporate techniques of tissue augmentation such as annular reinforcement and nuclear replacement. Adjunctive therapy such as chymopapain, injectable biomaterials that enhance tissue healing or endoscopic means of segmental stabilization or fusion will be an integral part of this technique.