Endoscopy treatment of lumbar disc struic disc sadged adjacent section yellow ligament cyst 1 case

Transdermal spinal endoscopy technology has been widely used in the treatment of various types of lumbar disc protrusion and lumbar spinal stenosis treatment, lumbar palsy cruciate ligament cyst due to very low incidence, by dermal spinal endoscopic technology to treat lumbar palsyapathcys were not retrieved related reportsRecently, the orthopaedic ten department of this hospital received the lumbar disc out of the merger of adjacent section symlias cyst patients 1 case, the application of single incision spinal endoscopy technology by the inter-vertebral treatment, to achieve satisfactory resultsIt is reported as follows:clinicalpatients, male, 74 years old; Specialist examination: L3/4 ratchet side pressure positive, right calf inside and outside feel slightly reduced, limb muscle strength is normal, right straight leg lift test 30 degrees , both sides of the knee tendon, Achilles tendon reflection normal, pathological reflex escticicity did not leadA visual simulation score of 7 for pain in the pre-surgery lumbar legAuxiliary examination: MRI shows: L4/5 intervertebral disc to the right rear upper and upper and l3 vertebral tube right rear swelling (Figure 1a)Admissiondiagnosis:(1) lumbar spinal stenosis; (2) L4/5 disc de-removal disease; (3) L3 epidural outer vertebral tube occupation, yellow ligament cyst semaphore is likelySurgical mode: single incision by the dermal vertebral inter-mirror L4/5 myelin core removal decompression and L3 vertebral swelling removal decompression testing , radio frequency ablation fiber ring thermocosisationsurgical methodlumbar satisfaction, take the position to increase the vertebral plate gap, according to the preoperative plan under the bone sign, rough body table position edited in L4/5 gap; Perspective confirmation, after confirmation take L4/5 gap center line right side open about 0.5CM to do vertical about 0.7CM skin incision, set up a working sleeve, tip arrived at the yellow ligament back edge, perspective positioning, perspective work channel satisfaction, connected endoscopy system, lens dialogue Fit, placed into the working channel, RF clean-up vision, see the yellow ligament backedge, blue pliers open yellow ligament, bite bone pliers to remove part of the yellow ligament, grinding out part of the L4 vertebral plate to expand the window, rotate the push work channel into the vertebrae, remove part of the yellow ligament and the outer bone The quality revealed the outer edge of the L5 nerve root, see the removal of myelin core, removal and disc removal loose myelin nucleus (retention examination), to detect the absence of residual myelin core, radiofrequency ablation fiber ring forming, see nerve without card pressure, lumbar disc de-removal surgery endedExit the work sleeve, the work sleeve according to the original incision tilt to the tail end tilt to establish the working channel, and perspective positioning, perspective work channel satisfied, connect the endoscopic system, RF clean-up vision, see the yellow ligament backedge, blue pliers bite open yellow ligament, bite bone clamp gradually open yellow ligament And see the yellow ligament level has a adhesive mucus-like substance (Figure 1c) (this biopsy was not successful), remove the swelling, see the yellow ligament around the non-adhesive mucus-like substance (Figure 1d), so the swelling is completely removed, nerve card pressure reliefSurgical, exit work sleeve, stitching, sterile accessories bandaged, ann return edging back to the wardpostoperative treatmentto dessemigo and other dehydration deflators after surgery treatment, after surgery, the 1d lumbar leg pain visual simulation score of 1 score; Postoperative follow-up 4 months to date lumbar leg pain visual simulation score of 0discussion
yellow ligament cyst is a rare degenerative lesions in the benign position of the vertebral tubeThe disease is good in the elderly, cervical, thoracic and lumbar vertebrae can occur, but the following lumbar spine is the most commonThe disease is often slow,clinicalhas no characteristic symptoms, generally manifested as lower back pain, when the yellow ligament cyst on the nerve root or epidural sac pressure, the corresponding clinical manifestations (such as nerve root pain)This case combines adjacent section lumbar disc de-emergence, the right l4/5 nerve root at the same time appear the corresponding symptomsclinically often need to be identified with glioscosis, tendon cysts and other vertebral cystsMRI imaging often manifests itself as a swollen matter with clear boundariesThe MRI imaging of the sliding membrane cyst is visible outside the area of the yellow ligament and is often connected with joint protrusionsThe MRI imaging of tendon cysts is visible outside the area of the yellow ligament and is adjacent to joint protrusions but not connectedWhile the yellow ligament cyst is located in the area of the yellow ligament in MRI imaging, the T1 weighted image usually appears as a low signal and can be mutated; Relevant studies have found that tuberculosis ligament cysts are located in the area of the yellow ligament, but have bone damageMRI is the key to identifyingdiagnosisand preliminary diagnosis, and further pathological examination is required for diagnosis The imaging of this case is consistent with typical MRI imaging at present, surgery to completely remove cysts decompression is the most effective way to treat spinal ligament cysts Spinal yellow ligament cysts generally open surgery to remove decompression With the development of minimally invasive technology, soft tissue and bone tissue can be treated and de-stressed Kim and others used endoscopes to successfully remove the decompression of the tuberculosis ligament cysts Endoscopy treatment has the advantages of minimally invasive, short surgery time and rapid recovery The application of this technique to treat and further confirm such diseases may require the adjustment of water pressure, followed by some of the yellow ligaments brought out together and other methods to remove a biopsy The nerve root of many sections is compressed, which leads to different corresponding root symptoms This case has both lumbar disc upward free out, and adjacent section of the yellow ligament cyst, and the nerve root pressure For simple lumbar disc upward free out can choose the intervertebral hole into the road or intervertebral plate into the spinal endoscopic treatment Several possible ways to choose spinal endoscopic therapy: the first is the double incision intervertebral hole into the road, this entrance requires intervertebral hole forming, both to increase the operation time, but also increase the amount of X-ray radiation, at the same time, the author believes that the cyst has been completely removed, the intervertebral hole into the road is difficult to grasp or completely remove the cyst damage to the joint, so it is not appropriate to use intervertebral hole into Road; the second is the double incision between the vertebral plate into the road, the yellow ligament vision is clearer, can be removed the yellow ligament full layer, whether the yellow ligament cyst is completely removed, has a better judgment, feasible; This case selected a third surgical method, and achieved satisfactory results In short, spinal endoscopy as a tool to provide a minimally invasive way of thinking to solve clinical problems It can be used for clinicians to learn from