How much do you know about minimally invasive spine surgeryPercutaneous puncture of lumbar intervertebral discEr Xing HeThe human interverte
How much do you know about minimally invasive spine surgery
Percutaneous puncture of lumbar intervertebral disc
Er Xing He
The human intervertebral disc is located between two adjacent vertebrae, the intervertebral space, which is composed of three parts: the micro ring, the nucleus pulposus and the cartilage plate. The nucleus is the central part of the fiber ring around, and cartilage like a lid seal the upper and lower sides.
Before the doctor thinks intradiscal pressure increase caused by lumbar disc herniation is some reason, cause the nucleus pulposus is squeezed out of the fiber ring gap. So, the design of a variety of treatments to remove the central part of the intervertebral disc nucleus pulposus. The technology from the last century in 60s so far, many species, but the concept of treatment is the same: resection of nucleus pulposus of intervertebral disc, hollowed out to reduce the Central Organization Department, volume, internal pressure is reduced, thereby reducing the outburst and reduce the surrounding tissue stimulation. This type of surgery is also called nucleus pulposus resection.
Now, people have a more in-depth understanding of the mechanism and pathology of intervertebral disc herniation, intervertebral disc herniation is not entirely due to increased internal pressure caused by prominent nucleus pulposus, intervertebral disc herniation is not all of the nucleus pulposus tissue. It may be that the nucleus pulposus, or the tear of the fibrous ring, or even the broken cartilage plate. Moreover, the intervertebral disc is not an elastic body, will not be like a balloon, reduce the internal pressure after the outstanding debris will automatically retract. There are many limitations in the treatment of this kind of treatment according to the earlier theory. At present, only a few patients are suitable for use.
The practical application shows that the pain of some patients can be relieved within a certain period of time. Moreover, this type of surgery is using percutaneous approach into the intervertebral disc, surgical trauma is small, was welcomed by patients. Therefore, there are still many doctors are still using these techniques for the treatment of patients with lumbar disc herniation.
The needle diameter percutaneous approach used by about 2 to 6mm after penetrating through the skin and muscles, in the lumbar intervertebral foramen (the intervertebral foramen, refer to my article: you know how many techniques of minimally invasive spine surgery -- endoscopic lumbar discectomy) into the intervertebral disc. This path has no bony structure and no bone removal, so the trauma is small. Through the hollow needle tract, nucleus pulposus of intervertebral disc resection using various means doctors. These include discolysis, vaporization, aspiration, planing, ablation, clamp operation etc..
The following is a brief introduction of several commonly used percutaneous endoscopic approach to nucleus pulposus resection:
As early as in the 60s of last century, the United States on the use of a kind of biological agent of papain, through the needle into the middle of the nucleus pulposus, biochemical reaction to the dissolution of the nucleus pulposus. This process and the use of the kitchen is very similar to beef meat tenderizer softening. The human body will have a serious allergic reaction to papain, the enzyme is currently used to collagen, the dissolution of the nucleus pulposus effect is slightly worse.
Two, radiofrequency ablation
Understand the principles of physics, people know that radio frequency energy, to achieve a certain amount of damage to the tissue cells. Use of bipolar devices used in the removal of nucleus pulposus, the energy generated between the two poles of the nucleus pulposus cells. The temperature produced by this process is not very high, generally does not affect the nearby nerve tissue. This is different from the ablation device used in the treatment of cancer, the latter will produce a temperature of 100 degrees, the foot can be cooked tissue cells.
Three, percutaneous nucleus pulposus automatic cutting
The use of surgical doctors in operation equipment is actually a rotating cutter, the nucleus of a bit to cut down and removed along the device.
Clamp the nucleus pliers can be said to be one of the most primitive tools, but in the percutaneous approach in the use of pliers is very exquisite. The surgeon will use this tool of nucleus pulposus clamp, consuming effort. The first generation of transforaminal endoscopic surgery is the use of pliers.
Five, laser vaporization
As the name suggests, is the use of laser energy to destroy the nucleus pulposus cells into a gas suction. The laser device is inserted into the nucleus through the hollow channel of the puncture needle.
The above operation, doctors can not directly see the nucleus pulposus, can not directly see whether the surgical tool has been placed in a predetermined position. In fact, can only rely on the X x-ray device to determine the position of the surgical instruments. Tools made of metal, not through X light. So, in the perspective of the image will be displayed. In the same way, the spine does not penetrate the X rays, which can be seen in the image. According to the relationship between the two kinds of images, the doctor can determine whether the tool is in the right position. In other words, X X-ray machine is an indispensable device for percutaneous puncture surgery.
In addition to the trauma of the surgery itself, the surgical procedure should be considered for the radiation damage caused by too much perspective.