PL-TOSP,经椎间孔内窥镜脊柱手术的新型入路点:通过前瞻性手术评估进行放射学分析,并对各种皮肤入路点进行文献回顾。

Asian journal of neurosurgery Pub Date : 2024-07-30 eCollection Date: 2024-12-01 DOI:10.1055/s-0044-1788680
Prasad Patgaonkar, Kiran Dhole, Sagar Kokate, Vaibhav Goyal, Vivek Patel, Ravi Patel
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引用次数: 0

摘要

本研究的目的是分析经椎间孔内窥镜脊柱手术中不同皮肤入路点的轨迹角度随体重、腹围和体重指数等身体参数变化的变化情况,并验证我们的假设:与目前可用的皮肤入路点相比,后外侧(PL)-棘突顶端(TOSP)入路点的轨迹角度变化最小。该研究包括对使用新型 PL-TOSP 技术接受经椎间孔内窥镜检查的患者的功能结果进行分析,评估疼痛和残疾的改善情况。根据 Kambin 的建议,经椎间孔内窥镜腰椎间盘切除术(TELD)的切入点是距中线 10 到 12 厘米的粗略距离,而 Yeung 和 Tsou 则建议切入点是椎间盘间隙中心与后侧皮肤线之间的距离。但切入点不可能是一成不变的,因为它们会随着物理参数的变化而变化。材料和方法 本研究包括对使用 PL-TOSP 切入点进行手术的患者进行放射学分析和前瞻性评估。放射学分析研究针对使用新型 PL-TOSP 切入点接受经椎间孔内窥镜手术的 50 名术前无症状患者。对患者进行了腰椎磁共振成像(MRI)视野(MRI-FOV)检查,包括腹部周围。核磁共振成像前记录了患者的体重、身高和腹围。利用 L45 和 L5S1 水平的 MRI-FOV 计算了 TELD 使用的四个标准进入点(即 45-45、PL、TOSP)、面关节背侧和我们建议的进入点 PL-TOSP(PL 和 TOSP 进入点之间的中点)的轨迹角度。在对这50名患者进行功能结果分析时,记录了他们术前的下肢疼痛视觉模拟评分(VAS)和Oswestry残疾指数(ODI)。术后2周、6周和12周再次评估VAS和ODI评分。进行统计分析以评估术前与术后 VAS 评分和 ODI 变化的显著性。结果 五个切入点与水平线的轨迹角度随物理参数的变化而变化。与其他切入点相比,PL-TOSP 切入点随物理参数变化的变化最小。PL-TOSP 进入点的角度范围为 21 至 29 度。在我们的研究中,术后 VAS 和 ODI 评分系统均有改善,这在统计学上具有显著意义(p -value 结论 用于经椎间孔内窥镜检查的新型 PL-TOSP 切入点在物理参数发生变化的情况下仍能显示出优越的轨迹角度稳定性,并能显著改善下肢根神经病患者的功能预后和疼痛减轻情况。PL-TOSP 的轨迹与水平面的夹角也与当前一代内窥镜(25 或 30 度)一致。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points.

Objective  Aim of this study was to analyze variation in angulation of trajectories of various skin entry points in transforaminal endoscopic spine surgery with change in the physical parameters, namely, weight, abdominal girth, and body mass index and to validate our hypothesis that posterolateral (PL)-tip of spinous process (TOSP) entry has minimal variation in the angle of trajectory as compared with currently available skin entry points. The study included an analysis of the functional outcomes of these patients who underwent transforaminal endoscopy using the novel PL-TOSP technique, assessing improvements in pain and disability. Entry point in transforaminal endoscopic lumbar discectomy (TELD) was taken as a rough distance of 10 to 12 cm from midline as proposed by Kambin whereas Yeung and Tsou advised entry point as distance between the center of the disc space and the posterior skin line measured on lateral. But entry points cannot be static as they tend to change according to changes in physical parameters. Materials and Methods  This study comprises of radiological analysis and a prospective evaluation of these patients operated on using the PL-TOSP entry point. Radiological analytic study was performed on 50 symptomatic preoperative patients who underwent transforaminal endoscopy using the novel PL-TOSP entry point. A lumbar spine magnetic resonance imaging (MRI) field of vision (MRI-FOV) was performed for the patients including the abdominal perimeter. Weight, height, and abdominal girth of the patients were noted prior to MRI. Angulation of trajectory made by four standard entry points used in TELD, namely, 45-45, PL, TOSP), dorsum of facet joint, and our proposed entry point PL-TOSP (which is a midpoint between PL and TOSP entry), were calculated using MRI-FOV at L45 and L5S1 level. For the functional outcome analysis of these 50 patients, preoperative Visual Analogue Score (VAS) for lower limb pain and Oswestry Disability Index (ODI) were recorded. Postoperative VAS and ODI scores were reassessed at 2, 6, and 12 weeks. Statistical analysis was conducted to evaluate the significance of changes in VAS scores and ODI preoperative versus postoperative. A p -value of < 0.05 was considered statistically significant. Results  Angle of trajectory with the horizontal for all five entry points varies with physical parameters. PL-TOSP entry point has the least variation with change in physical parameters as compared with other entry points. The range of angle for PL-TOSP entry was 21 to 29 degrees. In our study, there was improvement in postoperative VAS and ODI scoring systems which was statistically significant ( p -value < 0.05). This suggests reliability of our proposed entry point with consistent postoperative improvement. Conclusion  The novel PL-TOSP entry point for transforaminal endoscopy demonstrates superior stability in trajectory angle despite variations in physical parameters, and is associated with significant improvements in functional outcomes and pain reduction for patients with lower limb radiculopathy. Angulation of PL-TOSP trajectory with horizontal also corresponds to current generation of endoscopes (25 or 30 degrees).

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