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プロトコルは、Nanoori 病院の人間研究倫理委員会のガイドラインに従います。書面によるインフォームド コンセントは、腰椎椎間板の脱出による一方的な下下肢神経根障害を持つすべての患者から得られました。除外基準は、区域の不安定性の存在、すべり症 (グレード 1 以上)、および重要な脊柱管狭窄症の存在だった。
1. 患者位置と皮膚マーキング
<ol><li>わずかな屈曲で背骨と radiolucent オペレーティング テーブルの上腹臥位で患者を置きます。 注: 患者の外科のための徴候は次のとおり: 難治性、頻繁に一方的な保守的に神経根障害耐性対策 (少なくとも 6-8 週間)、関連付けられた軸のバックの有無痛み、身体検査、上の肯定的な張力標識や神経根症確証の MRI 研究で明らかに相関関連づけること。</li>
	<li>マーキング ペン イメージインテンシファイアの下で腸骨稜の範囲だけでなく、背骨の正中線をマークします。</li>
	<li>手動バック評価方法6を使用してディスク領域の中心に沿って傍脊柱皮膚エントリ ポイントをマーク: 背中の筋肉と腹筋の境界線をチェックします。両方中間のディスク レベル前後 (AP) のこの境界線の内側皮膚エントリ ポイントをマークし、横方向の x 線。</li>
</ol>2. 局所麻酔・切開
<ol><li>エントリ ポイントの周囲皮下の局所麻酔薬 (1% リドカイン 2 mL) に潜入し、約 1 cm の皮膚切開を行う 23 G 針で局所麻酔薬 (1% リドカインの 3 mL) 軌道に潜入します。</li>
	<li>皮膚切開 18 G 脊髄針を水平に 25-35 ° の角度で挿入します。</li>
	<li>イメージ ・ インテンシファイヤー筋や背中の筋肉の下に針を渡します。その後、椎間板の近くの Kambin の三角形で針をドッキングします。 注: Kambin の三角形ディスクの後外側面ではあります。斜辺は既存の神経根、下の椎体の上縁は、高さが thecal sac/横断神経根。</li>
	<li>イメージインテンシファイアの下で造影剤の 1.5 mL を注入することにより Kambin の三角形で無料の硬膜外腔を確認してください。1.6% リドカイン (8 mL の生理食塩水 2 mL とエピネフリン 0.05 mL 2% リドカイン) の 2-4 mL のブースター注入による椎間孔スペースと、1% リドカインの 8-10 mL を注入することにより Kambin の三角形で局所麻酔を提供する最初の注射後の 4-5 分。</li>
</ol>3 ディスコグラフィー
<ol><li>透視下椎間板のスペースに針を挿入し、コントラスト和え 0.8% インディゴ カルミネの 2 mL を注射することによって作品を実行します。</li>
</ol>4. 内視鏡の挿入
<ol><li>針を椎間板のスペースにガイドワイヤーを挿入し、針を削除します。</li>
	<li>挿入したガイドワイヤーを通して Kambin の三角形で閉鎖をスライドさせ、ディスク スペースの表面にアンカーします。</li>
	<li>Obturator を通じて作業のカニューレを挿入し、その後、Kambin の三角形に内視鏡を導入します。 注: 作業カニューレは外径 8 mm の傾斜型です。内視鏡は、表示角度、7.3 mm 外径、4.7 mm 作業チャネル、251 mm 全長の 30 ° を持っています。一定の生理食塩水灌漑を使用して全体のプロシージャが実行されます。</li>
</ol>5. 手術
<ol><li>ディスク (図 1 a) 入国前に内視鏡で Kambin の三角形の硬膜外脂肪と軟組織を観察します。</li>
	<li>高周波凝固装置を用いた環状上軟部組織と血管をクリアします。環状カッターで環状開窓を行い、内視鏡下で輪を入力してください。 注: アプローチ中に終了し、トラバースの神経根への損傷を避けるためには、処理は継続的なフィードバックを持つ患者から。</li>
	<li>穴あき管内カニューレの面取りの種類を挿入することで硬膜外腔とディスク スペースの半 々 ビューを取得します。 注: 背の半分、半 々、後縦靱帯、硬膜外腔とトラバース神経根、硬膜の見ることができます。腹側の半分にアニュラスと後縦靱帯に腹側のディスクを見ることができます。</li>
	<li>レバー下正確な半 々 を達成するために作業のカニューレは、7 (図 2 aおよび2 b) を表示します。 注: は、ベベル型作業カニューレを使用して、簡単じゃない既存の神経根を安全に操作する初心者のためラウンド作業カニューレもできますので (図 3) を使用します。</li>
</ol>6. ターゲット Fragmentectomy
<ol><li>椎間板を十分に伸長した後症候性ディスク領域に向けての軌道を変更します。 注: 作業チャネルは劣るで移行したディスクの高運河侵害されたディスクで硬膜外腔と、優れた移行ディスク (図 3) で椎間孔領域の suprapedicular 切り込みに向かって送られます。</li>
	<li>ディスクのすべての空きフラグメント チェックして浮遊硬膜嚢、既存ルートとトラバース ルート削除、回転作業チャネルと内視鏡による硬膜外腔を無料を確認します。 注: すべての患者は、(図 4および図 5) 手術翌日に MRI を受けます。</li>
</ol>

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著者が明らかに何もありません。

研究は、当研究所の管理下にあった 184 腰椎椎間板疾患患者の将来の分析に基づいています。X 線イメージング、計算された断層レントゲン写真撮影 (CT) や磁気共鳴画像 (MRI) は全例診断を確定し、他の疾患を除外するために行われました。CT や MRI スキャンで示される結果は、神経学的検査と相関しました。適切な診断後患者は PETLD のモバイル アウトサイドイン手法でに作動しました。除外?...

fChronic 腰痛と足の痛みは、どんな社会で一般的な病気です。腰椎椎間板症の治療法は、絶えず進化しています。装備一式は広い、開腹手術と microlumbar 椎間板切除術および今内視鏡ルート1,2,3,4に固定されています。Parvez Kambin によって最初に提案された切開経路は、介護5,6、7の標準を徐々 になっています。完全内視鏡下脊椎手術の利点は、少ない軟部組織解離、少ない出血、減らされた病院受付日、早期の機能回復、8生活の質の向上です。
シューベルトとフォルテ4によって与えられる PETLD の伝統的な外のアプローチはリーマを使用して作業カニューレ孔に導入し、孔の拡大を扱っています。外のアプローチの新たな手法の背後にある理論的根拠は、それ依存しないことだけすべてのケースで孔を拡大する方法をここでは言及しました。テクニックは、作業カニューレ孔し、内視鏡9,10の下で、ターゲット フラグメントへのカニューレの動き内の正確な配置について説明します。解剖学的, 切開空間に 3 つの異なるルートがあるし、外の技術と経皮的内視鏡下脊椎手術を腰椎椎間板ヘルニアの広い範囲に適用できる効果的に使用されている場合。中央、傍、および危険にさらされた乳酸脱水素酵素 (LDH) は椎間ルートによって近づかれる高い運河椎間孔、遠く外側上方に移行した LDH は椎間孔のルートによって近づかれ、下方に移行した LDH は suprapedicular ルート6によって近づかれます。この手法の利点は、少ない椎間板損傷と通常の解剖学的構造を保持、硬膜外の露出が容易で作業カニューレ孔での操作は困難ではないです。説明する手法は、孔内の構造の正確なビジョンを提供し、孔の拡大ではなく、孔内カニューレの正確な配置に焦点を当てていますので、以前のものとは異なります。テクニックはインサイド アウト手法として同様に安全構造、特に押し出しフラグメントの扱いやすさを提供しています。本研究の目的は、移行、上下中央、傍、椎間孔、遠い外側椎間板脱出のさまざまな種類の管理にこの手法の汎用性を証明し、高運河を危険にさらす場合です。技術はただし、長い学習曲線を要求し、初心者が学びながら患者をする必要がありますので。

<table><tbody><tr><td>Contrast dye injection</td><td>Iobrix injection, Taejoon pharm,Seoul, Korea</td><td>S.No. 1</td><td></td></tr><tr><td>0.8% indigo carmine</td><td>Carmine, Korea United Pharmaceutical, Yoenki, Korea</td><td>S.No. 2</td><td></td></tr><tr><td>30&amp;deg; endoscope</td><td>Joimax GmbH, Germany</td><td>S.No. 3</td><td></td></tr><tr><td>Radiofrequency coagulator</td><td>Elliquence, New York, USA</td><td>S.No. 4</td><td></td></tr><tr><td>Drill</td><td>Primado 2 NSK, Tochigi, Japan</td><td>S.No. 5</td><td></td></tr></tbody></table>

a mobile outside-in technique of transforaminal lumbar endoscopy for lumbar disc herniations

経皮的内視鏡的切開腰椎椎間板切除術 (PETLD) は、腰椎椎間板疾患の管理の標準となっています。ディスクに関して作業カニューレの導入のための 2 つの方法があります-アウトサイドイン、インサイド アウト。この前向き研究の目的は、モバイル アウトサイドイン手法椎間板脱出のさまざまな種類をあつかう上での技術的側面を説明します。腰椎椎間板脱出のため片側下下肢神経根障害と 184 の連続した患者の合計は、PETLD のモバイル アウトサイドイン手法でに作動しました。その臨床結果は、Macnab 基準オスウェストリー障害索引 (ODI)、ビジュアル アナログ スケール (VAS) 足の疼痛スコアを有した椎間板脱出の種類に基づいて評価しました。減圧の完全性は、磁気共鳴イメージングの術後で文書化されました。患者の平均年齢は 50 ± 16 歳、男女比 2:1 であった。平均観察期間 19 ± 6 ヵ月であった。合計 190 腰椎レベルで作動した (L1-L2: n = 4、L2-L3: n = 17、L3-L4: n = 27、L4-5: n = 123 と L5-S1: n = 19)。種類に分け、患者の分布は中央: n = 14、傍: n = 74、椎間孔: n = 28、遠く外側: n = 13、優れた移行: n = 8、下移行: n = 38、および高い運河妥協: n = 9。平均手術時間は 35 ± 12 (25-56) 分と平均入院 (1-3) 日 1.2 ± 0.5 であった。足の痛みの VAS スコア改善 7.5 ± 1 から 1.7 ± 0.9.70 ± から改善、ODI 8.3 を 23 ± 5。Macnab の基準に従って 75 例 (40.8%) は優秀な結果を持っていた、104 例 (56.5%) 良い結果が出て、5 例 (2.7%) は公正な結果を持っていた。(7.89%) で作動した 190 レベル 15 で再発 (初期および後期を含む) を見た。この記事では、モバイルの方法で孔内の高精度着陸に依存して、孔の拡大にのみ依存しない小説外のアプローチを示します。アプリケーションで汎用性の高い、椎間板脱出のすべてのタイプの管理では、厳しい運河妥協や高移行にも便利です。

アウトカム評価:
手術の結果は、VAS 脚痛みスコア11、12ODI および Macnab 基準13により測定しました。これらは術前の期間のフォロー アップ訪問 (外科手術の後、最後のフォロー アップに 3 ヵ月後 1 週) の間に測定した.
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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

腰椎椎間板ヘルニアの切開腰椎内視鏡外でモバイルの技術

腰椎椎間板ヘルニアの切開内視鏡椎間板切除術の新たなアウトサイドイン手法のプロトコルをご紹介します。184 患者治療の結果、使用の広い適応手法の技術的な側面は、詳細に説明します。

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

a-mobile-outside-technique-transforaminal-lumbar-endoscopy-for-lumbar

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

11.8K ビュー.  Nanoori Hospital. 腰椎椎間板ヘルニアの切開内視鏡椎間板切除術の新たなアウトサイドイン手法のプロトコルをご紹介します。184 患者治療の結果、使用の広い適応手法の技術的な側面は、詳細に説明します。

ビデオ: A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods of FMT administration have been reported in the literature including nasogastric tube, upper endoscopy, enema and colonoscopy. FMT via colonoscopy yields excellent cure rates and is also well tolerated. We have found that patients find this an acceptable and tolerable mode of delivery. At our Center, we have initiated a fecal transplant program for patients with recurrent or refractory CDI. We have developed a protocol using an iterative process of revision and have performed 24 fecal transplants on 22 patients with success rates comparable to the current published literature. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool maximizes therapeutic success. Here we detail each step of the FMT protocol that can be carried out at any endoscopy center with a high degree of safety and success.

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Fecal Microbiota Transplantation via colonoscopy is a safe and effective treatment for recurrent and refractory C.difficile infection. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool during the colonoscopy will maximize therapeutic success.

再発のための大腸内視鏡検査を経由して糞便細菌叢移植<em&gt; C。ディフィシル</em&gt;感染

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods ...

医学

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

麻酔、手術および収縮法を用いた経肛門用ねじの評価<em&gt;インビボ</em&gt;豚の腰椎モデル

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation

We report a novel technique for C-arm free transtubular L5 nerve decompression under CT-based navigation to reduce the radiation hazard. This procedure is performed under general anesthesia and neuromonitoring. The patient is placed in a prone position on an operating carbon table. A navigation reference frame is placed percutaneously into the contralateral sacroiliac joint or spinous process. Then, CT scan images are obtained. After instrument registration, the L5-S1 foraminal level is confirmed with a navigated probe, and the entry point is marked. Using an approximately 2 cm skin incision, the subcutaneous tissue and muscles are dissected. The navigated first dilator is aimed at the L5-S1 Kambin&#39;s triangle, and sequential dilation is performed. The 18 mm tube is used and fixed to the frame. The bone around the Kambin&#39;s triangle is removed with a navigated burr. For lateral disc herniation, the L5 nerve root is identified and retracted, and the disc fragment is removed. The navigation-guided tubular endoscopic decompression is an effective procedure. There is no radiation hazard to the surgeon or the operating room staff.

Presented here is a novel technique of C-arm free transtubular posterolateral decompression for lumbar foraminal stenosis and lateral disc herniation under O-arm navigation.

L5-S1腰椎側椎間板ヘルニアのための経管内視鏡的後側方減圧

We report a novel technique for C-arm free transtubular L5 nerve decompression under CT-based navigation to reduce the radiation hazard. This procedure is ...

神経科学

Full-Endoscopic Transforaminal Approach for Lumbar Discectomy

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.

<meta charset="utf8"></head><body>腰椎椎間板切除術のための全内視鏡的経椎間孔アプローチ

The present protocol describes the full-endoscopic transforaminal approach for lumbar discectomy, which is a safe technique that does not require muscle retraction or bone removal.

腰椎椎間板切除術のための全内視鏡的経椎間孔アプローチ

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes ...

Full Endoscopic Transforaminal Thoracic Discectomy Operative Technique

Thoracic disc herniations are a degenerative pathology of the thoracic spine wherein a portion of nucleus pulposis herniates into the epidural space, potentially causing spinal cord or nerve root compression. Traditional surgical treatment for patients with thoracic disc herniations requires relatively invasive anterior or posterolateral approaches that involve extensive muscular dissection and removal of bone in order to access and remove the disc herniation without causing undue compression of the spinal cord. Full endoscopic thoracic discectomy is a minimally invasive technique which allows for the resection of thoracic disc herniations through a small (1 cm) incision, minimizing collateral tissue trauma and obviating the need for the extensive muscle dissection and bony removal required for traditional surgical approaches. In this article, we describe in detail the operative technique for full endoscopic thoracic discectomy and discuss the pearls and pitfalls of the technique. We also provide a review of the outcomes and complications as seen in the literature.

<meta charset="utf8"></head><body>完全内視鏡的経椎間孔胸部椎間板切除術術

This protocol demonstrates the surgical technique for full endoscopic transforaminal resection of thoracic disc herniations.

完全内視鏡的経椎間孔胸部椎間板切除術術

Thoracic disc herniations are a degenerative pathology of the thoracic spine wherein a portion of nucleus pulposis herniates into the epidural space, ...

Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation

The full endoscopic interlaminar approach (FEILA) is a minimally invasive technique for lumbar discectomy. It has multiple advantages over other conventional discectomy methods, including less traumatization of the soft tissues, fewer complication rates (dural injury, bleeding), rapid rehabilitation, quick return to daily life activities, and preferable cosmetic results. FEILA is a surgery with a relatively steep learning adaptation. Endoscopic surgery is a closed tubular approach, and all surgical maneuvers are performed within a uniportal single working channel. Also, the technique has not yet been standardized and well-documented. Therefore, the early learning stages of this technique may not be easy for most surgeons. Despite these, FEILA is easy, and the operation length is comparable to and even shorter than other techniques of lumbar discectomy. FEILA for lumbar discectomy could be considered a safe and effective alternative procedure for paracentral L5-S1 disc herniation. Here, we describe the technique of FEILA, including every cutoff step required to reach technical proficiency for surgeons who want to start applying this approach.

<meta charset="utf8"></head><body>傍中心L5-S1椎間板ヘルニアに対する完全内視鏡的層間アプローチ

Here, we present a protocol to describe the full endoscopic interlaminar approach (FEILA) technique, including every cutoff step required to reach technical proficiency. FEILA is a surgery with a relatively steep learning adaptation. Despite this, any surgeon capable of microdiscectomy can perform FEILA with enough practice and suitable patient selection.

傍中心L5-S1椎間板ヘルニアに対する完全内視鏡的層間アプローチ

The full endoscopic interlaminar approach (FEILA) is a minimally invasive technique for lumbar discectomy. It has multiple advantages over other ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

腰椎椎間板ヘルニア治療のための全内視鏡的隔離ゾーン技術

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

腰椎椎間板ヘルニアの切開腰椎内視鏡外でモバイルの技術

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再発のための大腸内視鏡検査を経由して糞便細菌叢移植

麻酔、手術および収縮法を用いた経肛門用ねじの評価

L5-S1腰椎側椎間板ヘルニアのための経管内視鏡的後側方減圧

腰椎椎間板切除術のための全内視鏡的経椎間孔アプローチ

腰椎椎間板切除術のための全内視鏡的経椎間孔アプローチ

完全内視鏡的経椎間孔胸部椎間板切除術術

完全内視鏡的経椎間孔胸部椎間板切除術術

傍中心L5-S1椎間板ヘルニアに対する完全内視鏡的層間アプローチ

傍中心L5-S1椎間板ヘルニアに対する完全内視鏡的層間アプローチ

腰椎椎間板ヘルニア治療のための全内視鏡的隔離ゾーン技術