Microsurgical resection of lumbar intraspinal cysts through unilateral hemilaminectomy approach using percutaneous tubular retractor system
YU Bo-fei,XU Jie, ZHENG Wu, XIAO Yu-hua, LIN Yuan, TIAN Jian-ping
Chinese Journal of Clinical Anatomy ›› 2018, Vol. 36 ›› Issue (5) : 569-573.
Microsurgical resection of lumbar intraspinal cysts through unilateral hemilaminectomy approach using percutaneous tubular retractor system
Objective To investigate the clinical effect of using percutaneous tubular retractor system on microsurgical resection of lumbar intraspinal cysts via unilateral hemilaminectomy. Methods We performed a retrospective analysis of the clinical data of 13 patients with lumbar intraspinal cysts treated via a unilateral hemilaminectomy approach using percutaneous tubular retractor system from June 2014 to January 2018, including synovial cyst (n=5), ganglion cyst (n=3), meningeal cyst (n=3) and epithelioid cyst (n=2). Clinical outcomes were assessed using the visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) scale. Computed tomography (CT) three-dimensional reconstruction of lumbar vertebrae was performed l week postoperatively, MRI plain scan and enhanced scan of lumbar vertebrae were conducted during the follow-up period. Results Mean operative time was 119.2 min (ranging from 74 to 200 min). Mean blood loss during surgery was approximately 61.5 mL (ranging from 40 to 105 mL). The mean duration of hospital stay was 6.7 days (ranging from 5 to 10 days). Patients were followed-up for a period of between 4 months and 47 months, with a mean follow-up time of 23.8 months. Complete resection was achieved in all patients without nerve root injury or cerebrospinal fluid leakage. Postoperative scores of VAS and JOA improved significantly versus preoperative ones(P<0.05). No postoperative spinal instability was identified by CT three-dimensional reconstruction of lumbar vertebrae, and no evidence of recurrence or secondary spinal deformity was observed in any patients during the postoperative follow-up period. Conclusion Unilateral hemilaminectomy approach using percutaneous tubular retractor system can be used to treat lumbar intraspinal cysts, such surgical procedures have characteristics of less trauma, faster recovery, reliable clinical effect and good postoperative spinal stability, which is worth of clinical promotion.
Lumbar intraspinal cyst; / Tubular retractor; / Minimally invasive surgery; / Hemilaminectomy
[1] Zander T, Rohlmann A, Kl?ckner C, et al. Influence of graded facetectomy and laminectomy on spinal biomechanics[J]. Eur Spine J, 2003,12(4): 427-434.
[2] Wei J, Song Y, Sun L, et al. Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a metaanalysis of randomized controlled trials[J]. Int Orthop, 2013, 37(7): 13151325.
[3] 范顺武, 方向前, 赵兴, 等. 微创经椎间孔腰椎椎体间融合术治疗下腰椎疾病[J]. 中华骨科杂志, 2007, 27(2): 81-85.
[4] 徐烁, 党小伍, 肖建春, 等. Quadrant通道下微创手术治疗胸腰椎骨折的临床分析[J]. 中国临床解剖学杂志, 2014, 32(4): 471-475.
[5] 鲍刚, 陈琛, 廉海平, 等. 经Quadrant通道显微手术切除椎管内肿瘤[J]. 西安交通大学学报(医学版), 2016, 37(2): 161-165.
[6] Zhuang YD, Cai GF, Fu CF, et al. Novel combination of paraspinal keyhole surgery with a tubular retractor system leads to significant improvements in lumbar intraspinal extramedullary schwannomas[J]. Oncol Lett, 2017, 14(6): 7873-7879.
[7] Xu J, Liu CH, Lin Y, et al. Microscopic minimally invasive keyhole technique for surgical resection of spinal dumbbell tumors[J]. World Neurosurg, 2017, 109: e110 - e117.
[8] 柳根哲, Munehito Yoshida, 徐林, 等. 显微内窥镜下手术治疗腰椎管内囊肿的初步探讨[J]. 中国矫形外科杂志, 2007, 15(1): 70-72.
[9] Artico M, Cervoni L, Carloia S, et al. Synovial cysts: clinical and neuroradiological aspects[J]. Acta Neurochir (Wien), 1997, 139(3): 176-181.
[10] Sandhu FA, Santiago P, Fessler RG, et al. Minimally invasive surgical treatment of lumbar synovial cysts[J]. Neurosurgery, 2004, 54(1): 107-112.
[11]Sehati N, Khoo LT, Holly LT. Treatment of lumbar synovial cysts using minimally invasive surgical techniques[J]. Neurosurg Focus, 2006, 20(3): E2.
[12] James A, Laufer I, Parikh K, et al. Lumbar juxtafacet cyst resection: the facet sparing contralateral minimally invasive surgical approach[J]. J Spinal Disord Tech, 2012, 25(2): E13-E17.
[13]Sukkarieh HG, Hitchon PW, Awe O, et al. Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases[J]. J Neurosurg Spine, 2015, 23(4): 444-450.
[14] Yin HB, Zhang D, Wu ZP, et al. Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine[J]. World J Surg Oncol, 2014, 12(1): 50.
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