経皮的椎間板切除術
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A percutaneous discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula.
Contents
- 1 Method
- 2 Percutaneous endoscopic lumbar discectomy
- 3 Indications
- 4 Fast mobilisation
- 5 Conclusion
- 6 References
- 7 External links
Method
The discectomy is performed through a cannula inserted through the back into the center of the vertebral disc under local anesthetic using a stylet. After the position of the stylet is confirmed to be correct using AP and Lateral X-ray views it is removed leaving the cannula in place. The disc material may be removed using surgical tools such as the Dekompressor or traditional manual surgical tools, however the manual instruments require a larger cannula and more disruption to the surrounding structures. Both the automated and manual percutaneous discectomy procedures produce similar results and reduction in disc height and pressure on the nerves to result in pain reduction.[1]
Percutaneous endoscopic lumbar discectomy
Percutaneous Endoscopic Lumbar Discectomy (PELD) is a step advance from lumbar microdiscectomy. PELD is a percutaneous surgical procedure for safe and sparing excision of herniated disc material. Even sequestered disc material—regardless of its size and level—that has slipped into the spinal channel can be removed with this minimally invasive method.[2]
Advantages of PELD
PELD offers a number of advantages in comparison to conventional methods:
- Immediate pain relief in 95% of the cases - study info needed
- Direct access to herniated disc/sequester
- The disc-annulus and the ligament remain intact
- No general anesthesia, only a sparing local anesthetic necessary
- Outpatient treatment
- Shorter rehabilitation -study info needed
- Faster return to profession and everyday life - study info needed
- Small incision (only one stitch) = hardly any scarring.[2]
Indications
PELD is indicated for all levels of disc prolapse, including L5/S1. Prolapsed and sequestrated discs can be safely treated with this technique. It is also indicated for lumbar canal stenosis where foraminoplasty[3] is performed to decompress the nerve root. It is also suitable for elderly patients, patients with cardiovascular problems, pregnant patients, and patients who are fearful of surgery and general anesthesia.
Fast mobilisation
Patients can leave the recovery room just two hours after the operation. They can travel home just one day after surgery, following checks from their surgeon and physiotherapist. Light office work can be taken up within a week. Physical work and sports are allowed after 6 weeks.
Conclusion
Although Percutaneous Endoscopic Lumbar Discectomy (PELD) is a technically difficult procedure with a long learning curve for the surgeon, it has proven an effective, safe, and successful treatment of herniated discs, with a minimal complication rate.[4]
References
- ^ "Percutaneous Endoscopic Lumbar Discectomy (PELD)". Novaspecialtysurgery.com. Retrieved 8 March 2013.
- ^ a b "Percutaneous Endoscopic Lumbar Discectomy". Paindoc4u.com. Retrieved 8 March 2013.
- ^ "Endoscopic laser foraminoplasty | Information for the public". NICE. Retrieved 2015-03-02.
- ^ "Home Treatment Herniated Lumbar Disc". Healing-and-health.com/. Retrieved 8 March 2013.
External links
UpToDate Contents
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- 1. 亜急性および慢性腰痛：外科治療subacute and chronic low back pain surgical treatment [show details]
…Minimally invasive techniques include percutaneous manual nucleotomy, percutaneous discectomy, laser discectomy, endoscopic discectomy, microendoscopic discectomy, and radiofrequency nucleoplasty . Tubular …
- 2. 学会が公開する診療ガイドラインのリンク：腰椎変性疾患society guideline links lower spine disorders [show details]
- 3. 非結核性抗酸菌感染症の疫学epidemiology of nontuberculous mycobacterial infections [show details]
…Fifty-eight cases of nosocomial spinal infection occurred in healthy patients following percutaneous nucleotomy for lower back pain or sciatica . The outbreak stemmed from the practice of rinsing the surgical…
English Journal
- Significance of preoperative planning software for puncture and channel establishment in percutaneous endoscopic lumbar DISCECTOMY: A study of 40 cases.
- Hu Z1, Li X2, Cui J2, He X3, Li C2, Han Y2, Pan J2, Yang M2, Tan J2, Li L4.
- International journal of surgery (London, England).Int J Surg.2017 May;41:97-103. doi: 10.1016/j.ijsu.2017.03.059. Epub 2017 Mar 23.
- PMID 28344159
- Combination of Transforaminal and Interlaminar Percutaneous Endoscopic Lumbar Diskectomy for Extensive Down-migrated Disk Herniation.
- Choi KC1, Lee JH1, Kim JS2, Lee DC1, Park CK3.
- Journal of neurological surgery. Part A, Central European neurosurgery.J Neurol Surg A Cent Eur Neurosurg.2017 Apr 28. doi: 10.1055/s-0037-1601875. [Epub ahead of print]
- PMID 28454187
- Trajectory planning and guided punctures with isocentric navigation in posterolateral endoscopic lumbar discectomy: technical note.
- Fan G, Wang C, Gu X, Zhang H, He S.
- World neurosurgery.World Neurosurg.2017 Apr 17. pii: S1878-8750(17)30529-6. doi: 10.1016/j.wneu.2017.04.034. [Epub ahead of print]
- BACKGROUND: Posterolateral endoscopic trasforaminal discectomy (PELD) requires an ideal percutaneous puncture to place the working channel for endoscopic discectomy. The conventional blinded punctures relies on the surgeons' experience and repeated fluoroscopy, which may increase radiation exposure.
- PMID 28427987
Japanese Journal
- 臨床経験 外側型腰椎椎間板ヘルニアに対する経皮的内視鏡下椎間板切除術(PELD)
- Clinical Significance of High-intensity Zone for Discogenic Low Back Pain: A Review
- Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report
Related Links
- (September 2009). A percutaneous discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula. Contents. 1 Method; 2 Percutaneous Endoscopic Lumbar Discectomy ...
- Discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord.
★リンクテーブル★
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- 英
- percutaneous nucleotomy PN
- 同
- 経皮的椎間板切除術 percutaneous discectomy percutaneous diskectomy PD
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- 英
- percutaneous discectomy percutaneous diskectomy PD
- 関
- 経皮的髄核摘出術
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- 関
- dermal、dermally、percutaneously、transcutaneous、transcutaneously、transdermal、transdermally、transepidermal