Clinical Outcomes Based on Preoperative Kambin's Triangular Working Zone Measurements on 3D CT/MR Fusion Imaging to Determine Optimal Approaches to Transforaminal Endoscopic Lumbar Diskectomy

作者: Jiro Hirayama , Masayuki Hashimoto , Takuya Sakamoto , None

DOI: 10.1055/S-0039-3400752

关键词: DysesthesiaCannulaMedicineVisual analogue scaleImage fusionNuclear medicineDiskectomyLumbarMagnetic resonance imagingLow back pain

摘要: Background Transforaminal endoscopic lumbar diskectomy (TELD) is a widely used minimally invasive surgical procedure to treat herniated disks. Postoperative dysesthesia (POD) significant complication that affects patient satisfaction. Several anatomical and magnetic resonance (MR) imaging studies of the intervertebral foramina showed TELD should be avoided in patients with small Kambin's triangular working zones. Recently, some reports indicated usefulness three-dimensional (3D) computed tomography/magnetic (CT/MR) fusion images. To date, no articles have been published English literature regarding use 3D CT/MR images before evaluate zone. Our objective was examine clinical outcomes when preoperative zone measurements from were determine approach TELD. Patients Methods We included 31 who underwent We rotated posteroanterior view on side angle at which appeared largest. This intraoperative insertion for cannula. When perpendicular line extending exiting nerve disk level upper margin superior articular process (exiting nerve-superior distance [ESD]) less than or equal 7 mm, an combined foraminoplasty outside-in technique (F + outside-in) used. compared ESD outcomes, such as POD, between approaches. Results Surgical plans based values 22 patients. 7 mm 21 patients, all whom F + outside-in. The inside-out eight nine did not measurements. Of these, five had retrospective 7 mm. mean 6.3 ± 1.0 mm 4.4 ± 1.6 mm F + outside-in used, difference. Significant improvements observed visual analog scale scores low back pain, lower limb paresthesia. There incidences POD complications. Conclusion Based images, selected smaller cannula diameter. method successfully our study. Preoperative can enhance safety during

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