关注内窥镜手术后局部麻木的问题

过去做开放手术的时候，我们也发现部分病人术后主诉，原先疼痛的部位会出现麻木的情况。过去的解释是神经减压后的麻木。我老师Antony Yeung进行了大量的临床和基础研究，提出了Furcal神经的概念。并在最近发表了多篇关于该问题的会议和学术文章。这是关于术后麻木的问题，欢迎同道共享北京301医院骨科张西峰

本篇的题目是：你需要知道的椎间孔显微解剖：经椎间孔外科的关键因素

另外一篇的题目是：

Furcal在椎间孔的存在影响了手术后感觉迟钝的发生率，是所有椎间孔手术方式不可避免的风险

What you need to know about the Micro-anatomy of the foramen: Critical considerations for transforaminal Surgery

 

Anthony T. Yeung, M.D.

 

Introduction: With the increasing acceptance of transforaminal surgery ranging from foraminal endoscopic surgery to insertion of surgical implants, knowledge of foraminal micro-anatomy will help the surgeon become aware of the surgical risks and the well known and less known surgical morbidity of this approach.

 

Method: A review of the literature is compared to cadaver dissections of the foramen and the visualization of normal and patho-anatomy in endoscopic foraminal surgery. The foramen of 10 cadaver lumbar trunk specimens from L1-S1 served as a reference.

 

Results:  There was considerable variation identified in all three methods, as there was disagreement in publications on foramenal anatomy, variation of foramenal anatomy of the exiting nerve in relation to the facets at each lumbar level, the finding of anomalous nerves branching from the exiting nerve (furcal nerves) and, in rare occasions even autonomic afferent nerves by endoscopic visualization and surgical biopsy in vivo.

 

Discussion:  The safety and efficacy of back surgery, especially endoscopic surgery, depends on complete comprehensive understanding of 3 dimensional correlative anatomy, especially the neural structures in relation to bony landmarks.  In transforaminal surgery, what the surgeon usually sees is the skin, the facet, and the annulus before entering the disc. Discectomy, disc preparation, and removal or avoidance of the disc endplate is often done by palpation.  Between the skin and bone, a great deal is left to guess work. There are many potential pitfalls operating in the foramen as surgeons try to avoid perfect their surgical skills and minimize surgical morbidity.

 

Conclusion:  This study describes why it may not be possible to avoid post-operative dysesthesia and identifies some of the pitfalls of this surgical approach. This will have a bearing on any image guided technique or needle developed for traversing the foramen due to the variations in foraminal anatomy of nerves and vasculature.