At present, the most commonly used clinical surgery respectively: into intervertebral disc decompression by indirect disc Kambin security tr
At present, the most commonly used clinical surgery respectively: into intervertebral disc decompression by indirect disc Kambin security triangle YESS technology and Hoogland design Yeung introduced the transforaminal expert directly into the spinal canal decompression of the nerve root decompression and TESSYS (Transforaminal Endoscopic Spine System) technology. While the two technologies are under local anesthesia through posterolateral lumbar discectomy, but in terms of location, direction of puncture and surgery operation casing are different.
YESS technology is in the original lumbar posterior percutaneous transforaminal endoscope based on percutaneous transforaminal endoscope system, a rigid rod combined, multi pipe, wide-angle designed, while the operation end of the casing tube is designed for slopes with different angles, but these design does not allow the surgeon in wide angle from the perspective of the single channel operation can be completed under direct disc resection and decompression of the nerve root, but also can see the epidural space, fiber ring in the same field under the wall and intradiscal space. In the specific operation skills, the intervertebral disc of lumbar Kambin into triangular safe area, the intervertebral disc gradually outward resection of intervertebral disc tissue, and in high speed drill, bipolar radiofrequency and side hole laser assisted intervertebral foramen enlargement of single channel or dual channel forming technology. YESS operation is relatively simple to operate and easy to master, but there are also indications of relatively narrow, difficult to remove prolapse of intervertebral disc tissue and free.
Hoogland aiming at the shortcoming of the YESS technology, design a set of different diameter of intervertebral foramen reamer, step by step on the part of the resection of vertebral facet before the lower edge of the bone structure, expand intervertebral foramen, surgery will work catheter directly into the spinal canal, direct endoscope, the dural space before directly removed from free or lumbar intervertebral disc tissue. The lumbar technique not only can handle various types of disc protrusion or extrusion, but also can directly remove the free disc tissue, and lumbar intervertebral foramen forming. The TESSYS operation is entering the spinal canal through intervertebral foramen after expanding, not only operation casing easier placement, and not through a relatively narrow range of Kambin triangle into the intervertebral disc, effectively prevent and reduce the damage to the travel puncture of nerve roots and dorsal root ganglia process and catheterization. However, there are some disadvantages such as high operation difficulty, long learning curve, vulnerable to injury of spinal canal, nerve root and dural sac.
Although these two techniques are different in operation, they all have their best indications. YESS technology is the most suitable for discogenic low back pain of nucleus pulposus decompression and tear annuloplasty, direct extraction and TESSYS technology is the most suitable for huge disc herniation and free disc tissue, there are two kinds of complementary relationship between technology. Therefore, we should not only grasp the correct operation of these two techniques in clinical, but also master and correctly select the best indications of these two kinds of surgery.
From the Xinqiao Hospital of Third Military Medical University Professor Zhou Yue