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首页> 外文期刊>Neurosurgical focus >Tubular microdiscectomy: techniques, complication avoidance, and review of the literature
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Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

机译：管状微盘切除术：技术，避免并发症和文献复习

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OBJECTIVE Microendoscopic discectomy is a minimally invasive surgery technique that was initially described in 1997. It allows surgeons to work with 2 hands through a small-diameter, operating table–mounted tubular retractor, and to apply standard microsurgical techniques in which a small skin incision and minimal muscle dissection are used. Whether the surgeon chooses to use an endoscope or a microscope for visualization, the technique uses the same type of retractor and is thus called tubular microdiscectomy. The goal in this study was to review the current literature, examine the level of evidence supporting tubular microdiscectomy, and describe surgical techniques for complication avoidance. METHODS The authors performed a systematic PubMed review using the terms “microdiscectomy trial,” “tubular and open microdiscectomy,” “microendoscopic open discectomy,” and “minimally invasive open microdiscectomy OR microdiskectomy.” Of 317 references, 10 manuscripts were included for analysis based on study design, relevance, and appropriate comparison of open to tubular discectomy. RESULTS Similar and very favorable clinical outcomes can be expected from tubular and standard microdiscectomy. Studies have demonstrated equivalent operating times for both procedures, with lower blood loss and shorter hospital stays associated with tubular microdiscectomy. Furthermore, postoperative analgesic usage has been shown to be significantly lower after tubular microdiscectomy. Overall rates of complications are no different for tubular and standard microdiscectomy. CONCLUSIONS Prospective randomized trials have been used to evaluate outcomes of common minimally invasive lumbar spine procedures. For lumbar discectomy, Level I evidence supports equivalently good outcomes for tubular microdiscectomy compared with standard microdiscectomy. Likewise, Level I data indicate similar safety profiles and may indicate lower blood loss for tubular microdiscectomy. Future studies should examine the comparative value of these procedures.
机译：目的显微内窥镜椎间盘切除术是一种微创手术技术，最初于1997年进行了描述。它允许外科医生用两只手通过小直径的手术台安装的管状牵开器进行手术，并应用标准的显微外科技术，其中包括一个小皮肤切口和一个小切口。使用最小的肌肉解剖。无论外科医生选择使用内窥镜还是显微镜进行可视化，该技术都使用相同类型的牵开器，因此被称为管状微盘切除术。这项研究的目的是回顾当前文献，检查支持管状微盘切除术的证据水平，并描述避免并发症的手术技术。方法作者使用术语“微盘切除术试验”，“管状和开放式微盘切除术”，“微内镜开放式盘切除术”和“微创开放式微盘切除术或微盘切除术”进行了系统的PubMed审查。在317篇参考文献中，根据研究设计，相关性以及对开放性管状椎间盘切除术的适当比较，纳入了10篇手稿进行分析。结果管状和标准微盘切除术有望获得相似且非常有利的临床结果。研究表明，两种手术的手术时间相当，与管状微盘切除术相比，出血量更低，住院时间更短。此外，肾小管切除术后的术后镇痛使用率已显着降低。肾小管切除术和标准微盘切除术的总并发症发生率没有差异。结论前瞻性随机试验已用于评估常见的微创腰椎手术的结果。对于腰椎间盘切除术，与标准微盘切除术相比，I级证据支持了管状微盘切除术的同等效果。同样，I级数据表明相似的安全性，并且可能表明输卵管微盘切除术的失血量降低。未来的研究应检查这些程序的比较价值。

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