JBJS essential surgical techniques · 2016
Minimally Invasive Decompression in Lumbar Spinal Stenosis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
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Lønne Greger, Cha Thomas D
Аннотация
INTRODUCTION: Unlike traditional open laminectomy, minimally invasive decompression (MID) spares the important midline structures of the spine (i.e., the spinous process and the supraspinous and interspinous ligaments).
STEP 1 PREOPERATIVE PLANNING: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan.
STEP 2 OPERATING ROOM SETUP: Ensure the correct positioning of the patient and the proper setup of the equipment.
STEP 3 MARKING THE LEVELS: Use fluoroscopy to localize the level(s) of the stenosis.
STEP 4 SKIN INCISION AND TUBE POSITIONING: Ensure the correct placement of the tube.
STEP 5 RESECTION OF THE LOWER PART OF THE LAMINA: Use a high-speed drill and Kerrison rongeur to enter the spinal canal.
STEP 6 RESECTION OF THE MEDIAL PART OF THE FACET JOINT: Proceed cautiously at the point where the spinal canal is usually narrowest.
STEP 7 RESECTION OF THE LIGAMENTUM FLAVUM: Resect the ligamentum flavum piecemeal with a Kerrison rongeur.
STEP 8 CROSSOVER TECHNIQUE OPTIONAL: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3).
STEP 9 CLOSING THE WOUND: Perform a check to be certain that all steps have been completed before closing the skin.
RESULTS: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.
STEP 1 PREOPERATIVE PLANNING: Determine the levels and laterality for the decompression on the basis of the symptoms and findings on the MRI scan.
STEP 2 OPERATING ROOM SETUP: Ensure the correct positioning of the patient and the proper setup of the equipment.
STEP 3 MARKING THE LEVELS: Use fluoroscopy to localize the level(s) of the stenosis.
STEP 4 SKIN INCISION AND TUBE POSITIONING: Ensure the correct placement of the tube.
STEP 5 RESECTION OF THE LOWER PART OF THE LAMINA: Use a high-speed drill and Kerrison rongeur to enter the spinal canal.
STEP 6 RESECTION OF THE MEDIAL PART OF THE FACET JOINT: Proceed cautiously at the point where the spinal canal is usually narrowest.
STEP 7 RESECTION OF THE LIGAMENTUM FLAVUM: Resect the ligamentum flavum piecemeal with a Kerrison rongeur.
STEP 8 CROSSOVER TECHNIQUE OPTIONAL: Use the crossover technique to reach across the midline and decompress the contralateral lateral recess (Video 3).
STEP 9 CLOSING THE WOUND: Perform a check to be certain that all steps have been completed before closing the skin.
RESULTS: In the study by Lønne et al., the 41 patients managed with MID had significant improvement at 6 weeks and throughout the 2-year observation period7.