医学课件病例讨论微创腰椎间融合手术

PRE-OP病例特点-病史女性，80岁，强迫体位，无法入眠右侧腰腿痛3年，加重伴间歇性跛行3月腰椎侧凸畸形，左/右SLR＝30°/70°右足背触痛觉减退，右伸踇肌力III级左/右膝反射＝+/+，左/右踝反射＝+/-PRE-OP

X-RAYPRE-OP

MRI治疗方案A保守治疗无效－症状重，难以忍受B手术治疗a单纯髓核摘除术(MED/椎间孔镜/小切口)

b腰4/5髓核摘除，DYNESYS动态固定术

cP-T-D-X-ALIFOR?

OLIFObliqueLumbarInterbodyFusionAnatomyofKambin’sTrianglePosteriorBorder–SAPInferiorBorder–VertebralEndplateSuperiorBorder–ExitingNerveDistanceFromMidlineDiscSpacePreparationandAccessSpinalNeedleAccessBallTippedProbeAccessGuideWireAccessBluntDilatorAccess9mmWorkingCannulaAccessAllDoneThroughKambin’sTriangleWithMaximalTissuePreservationDilatorDiameteris8mmDiscDrillremovesdiscnucleusandpreparesdiscspaceforotherdiscectomyinstruments.

Rotatingdiscshaperpassesthroughaccessportalandexpandsupto16mmforendplatepreparationAnimationofshaperturningindiscspacePituitaryrongeurgrabsdiscmaterialaftertherotatingDiscShaperisremovedPreparationForImplantInsertionInstrumentationAllowsaThoroughDiscectomyUniqueMinimalAccessInstrumentationAllowsRemovalofCartilaginousEndplatePreparationofaBleedingBoneBedBoneGraftingAllDoneThrougha9mmTube9mmDiscCutterexpandsasaloopcurettetodeflectleft,right,upanddownforthoroughdiscectomy.

AddBonegraftmaterial Wehaveacollagenspongeinfusedwithβ-TCPandHydroxyapatiteandhydratedwithbonemarrowaspirateProperplacementoftheZeus-OisachievedwhentheradiographicmarkersarelocatedonoppositesidesofthespinousprocessinanA/Pfluoroimage.

INTRA-OP

PostOLIF

CompleteResolutionofSymptomsPostOLIF

CompleteResolutionofSymptoms创伤小恢复快效果好并发症少住院周期短3-5天术后第1天AchievingFusionThroughAMinimallyInvasiveApproachSoftTissueTraumaPreservationofNormalMusculaturePreservationofNormalBonyStabilityPreservationofNormalStabilizingLigamentsViolationofEpiduralSpaceDeliveryApproach:TrulyMinimallyInvasiveDiscectomyandEndplatePreparationAreAllDoneT