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- 저자 : Taguchi Mitsuto (검색결과 3 건)
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Shu Nakamura,Mitsuto Taguchi 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.6
Study Design: Retrospective. Purpose: To analyze whether the cross-sectional area of the intervertebral foramen at the outermost edge of the resection site is associated with postoperative outcomes and whether our fluoroscopic method for determining the resection area is appropriate. Overview of Literature: There is no consensus on the criteria for determining an optimal resection area to obtain sufficient decompression while maintaining intervertebral stability in posterior percutaneous endoscopic cervical foraminotomy. Previous reports have recommended a facet resection rate (FRR) of ≤50%. Intervertebral foramen stenosis often extends to the exit zone. The crosssectional area of the intervertebral foramen is occasionally small at the outermost edge of the resection site. No report has analyzed whether these aspects are associated with postoperative outcomes. Methods: Lateral margins of the resection area were set at lateral borders of the vertebral body on frontal fluoroscopic view. Because the percutaneous endoscope has a small diameter, surrounding structures can easily be identified using frontal view fluoroscopy to determine the resection area. FRRs were calculated from postoperative computed tomography images. The smallest crosssectional area of the intervertebral foramen around the lateral edge of the resection area (SALE) was measured and compared with clinical outcomes. Results: The mean FRR was 41.7% at C5–C6 and 48.9% at C6–C7. SALE was not correlated with clinical outcomes. Conclusions: Residual stenosis in the lateral portion of the intervertebral foramen is weakly associated with postoperative outcomes. Our process achieved adequate FRRs and favorable postoperative outcomes, suggesting that our criteria for determining the resection area are appropriate.
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Nakamura Shu,Taguchi Mitsuto 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4
Study Design: A preliminary case series study.Purpose: For the safety of performing a posterior percutaneous full-endoscopic cervical discectomy.Overview of Literature: Because of the lack of space for inserting an outer sheath above the intervertebral disc in the spinal canal, grasping the herniated disc with forceps while retracting the nerves with the forceps itself was required. This procedure produces the risk of inadvertently injuring nerves because of inadequate visualization of the hernia and inadequate protection of the nerve.Methods: Our new internal retractor can be inserted into the working channel of a percutaneous full-endoscope, enabling the insertion of a second tool. After partial foraminotomy, the internal retractor and forceps were manipulated to reliably retract the nerve root. Finally, the herniated disc was resected under an endoscopic view.Results: All six cases had a good postoperative course, and postoperative neuropathy was not observed.Conclusions: This internal retractor allows for the secure resection herniated cervical intervertebral discs.
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Percutaneous Endoscopic Cervical Discectomy: Surgical Approaches and Postoperative Imaging Changes
Shu Nakamura,Mitsuto Taguchi 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2
Study Design: Retrospective clinical study. Purpose: This study investigated the relationship between surgical approaches and surgical outcomes in patients undergoing percutaneous endoscopic cervical discectomy (PECD), including the reduction in intervertebral disc height and the incidence of Modic changes. Overview of Literature: The anterior approach involves partial invasion of the intervertebral disc, with a reported reduction in intervertebral disc height after PECD. Methods: Forty-two patients with cervical disk hernia who underwent PECD and magnetic resonance imaging at least 3 months postoperatively were divided into four groups according to the hernia sites and the surgical approach used: unilateral hernia treated using the contralateral approach (group C, n=18), unilateral hernia treated using the ipsilateral approach (group I, n=15), midline hernia (group M, n=4), and broad and bilateral hernia (group B, n=5). Modic changes and intervertebral disc height were evaluated. Results: The overall incidence of Modic changes was 52.4%: 72.2% in group C, 26.7% in group I, 25.0% in group M, and 80.0% in group B. The reduction in intervertebral disc height was 21.8% across all the patients: 24.5% in group C, 11.0% in group I, 22.8% in group M, and 23.9% in group B. Conclusions: The incidence of Modic changes and the reduction in intervertebral disc height were lower in the patients treated using the ipsilateral approach than in those treated using the contralateral approach. Traditionally, a contralateral approach has been used for PECD; however, the ipsilateral approach is more appropriate and is therefore recommended.
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