Foraminoscope is an instrument used in a minimally invasive surgery for the treatment of herniated intervertebral disc. Through the intervertebral foraminal mirror, a tube can be used to enter the protruding intervertebral disc and remove the protruding intervertebral disc that compresses the nerve. It can effectively improve the pain and numbness of the patient's lower limbs. Small trauma and quick recovery are now gradually becoming a popular trend in the treatment of intervertebral disc herniation.
Principles of Treatment
Intervertebral foramoscope removes the protruding or prolapsed nucleus pulposus and hyperplastic bone completely outside the safety triangle of the intervertebral foramen and the annulus of the intervertebral disc to relieve the pressure on the nerve root and eliminate the pain caused by the compression of the nerve. The surgical method is a spine minimally invasive surgery system composed of a specially designed intervertebral foraminal lens and corresponding supporting spine minimally invasive surgical instruments, endoscopic camera systems, and medical monitors. While completely removing the protruding or prolapsed nucleus pulposus, it can remove bone hyperplasia, treat spinal canal stenosis, and use radio frequency technology to repair damaged annulus.
Approach position
1. For cases of simple disc herniation and partial prolapse, the posterolateral safety triangle approach is preferred.
2. The far lateral horizontal approach is suitable for a huge central protrusion.
3. The posterior approach or interlaminar approach is suitable for free or calcified patients
4. Applicable to almost all types of intervertebral disc herniation and partial bony stenosis cases
Adapt to the crowd
There is no essential difference between the selection criteria for foraminal or endoscopic microscopic discectomy and the selection criteria for laminectomy and discectomy. Patients with intervertebral disc herniation who choose to undergo minimally invasive surgery must exhibit symptoms and signs of nerve root compression, and must meet the following conditions:
1. Continuous or recurrent radicular pain;
2. Radical pain is heavier than low back pain. For patients with low back pain symptoms greater than leg pain and moderate bulging, low-temperature plasma nucleoplasty can be performed first;
3. Ineffective after strict conservative treatment. Including the use of steroidal or non-steroidal anti-inflammatory analgesics, physical therapy, occupational or conditional training procedures, conservative treatment is recommended for at least 4-6 weeks, but if neurological symptoms are progressively worsening, immediate surgery is required;
4. No history of drug abuse or mental illness;
5. The straight leg raising test is positive, and it is difficult to bend over;
6. In order to accurately determine the position and nature of the prolapsed or prolapsed nucleus pulposus, as well as the bone hyperplasia of the intervertebral foramen, a thorough imaging examination must be performed before surgery, especially CT and MRI are used to accurately determine the size and location of the nucleus pulposus And an important means of nature.
Skills for successful operation:
1. Preoperative evaluation and positioning.
2. During the operation, the 16G puncture needle must reach the upper articular shoulder of the lower vertebral body.
3. The first-level guide rod must be close to the upper articular shoulder, with a touch feeling, which is conducive to the accurate position of the working casing.
4. The working casing can be rotated up and down, left and right, to find the target more accurately.
5. The trephine under the frontal fluoroscopy is not allowed to exceed the inner edge of the upper and lower pedicle connection. When the intervertebral foramen is not narrow, the articular process can not be cut.
Precautions during operation:
1. During the operation, the patients should be asked about their feelings. If radicular pain and numbness occur, stop the operation immediately and change the angle of the cannula.
2. For local anesthesia of facet joints, use 0.5% lidocaine, which is a high proportion.
3. During the operation, if there is blood vessel bleeding in the spinal canal, if the bipolar radio frequency click still cannot be stopped, you can use a mirror or nucleus pulposus forceps to stop the bleeding, you can also spray the pavilion or use the hemostatic gauze s100 to fill it.