Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(03): 185-194
DOI: 10.1055/s-0035-1554047
Original Article | Artigo Original
Thieme Publicações Ltda Rio de Janeiro, Brazil

Microdiscectomia lombar: acessos interlaminar e intertransverso com uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliar no afastamento da musculatura – estudo de 502 casos

Lumbar Microdiscectomy: Interlaminar and Intertransverso Access using Tubular Retractor Caspar Cylindrical and Penrose Drain as an Aid in Muscular Retraction – Study of 502 Cases
José Calasans dos Santos
1   Membro titular da Sociedade e da Academia Brasileira de Neurocirurgia. Membro Efetivo da Sociedade Brasileira de Coluna. Chefe do serviço de Neurocirurgia do Hospital da Unimed, Aracaju, Sergipe, Brasil
,
Camila Ricci Calasans
2   Acadêmico de Medicina da Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brasil
,
Victor Gama Mascarenhas
2   Acadêmico de Medicina da Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brasil
› Author Affiliations
Further Information

Publication History

25 August 2014

31 March 2015

Publication Date:
03 August 2015 (online)

Resumo

Os autores fazem uma revisão da literatura abordando conhecimentos neuroanatômicos da raiz e do gânglio da raiz dorsal. Descrevem a técnica para os acessos interlaminar e intertransverso com o uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliares no afastamento da musculatura. Basearam-se em 502 casos operados em 25 anos. O objetivo deste trabalho é descrever uma técnica com incisão pequena na pele, baixa agressividade para as estruturas anatômicas, sem perda funcional da musculatura paravertebral, campo cirúrgico amplo, facilidade de execução com as duas mãos, alta hospitalar precoce em torno de 24 horas e baixo custo.

Abstract

The authors review the literature addressing neuro-anatomical knowledge of the root and root ganglion dorsal. Describe the technique for the interlaminar and intertransverso access using tubular retractor Caspar cylindrical Penrose drain as an aid in muscular retraction. Based-seem 502 cases operated in 25 years. The objective of this paper is to describe a technique with small skin incision, low aggressiveness anatomical structures without functional loss of paraspinal musculature, broad surgical field, easy work with both hands, high early hospital about 24 hours and low cost.

 
  • Referências

  • 1 Rothman RS, Simeone FA. La coluna vertebral. Buenos Aires: Panamerica; 1985: 476-662
  • 2 Santos JC, Lima PJC. Microdiscectomia lombar: técnica e resultados em 80 casos. Arq Neuropsiq 1993; 51 (2) 205
  • 3 Oppenheim H, Krause F. Uber Einklemmung bzw Strangulation der Cauda equina. Dtsch Med 1909; 35: 697-700
  • 4 Mixter WS, Barr IS. Rupture of intervertebral disc without involvement of the spinal cord. N Engl J Med 1934; 211: 210-215
  • 5 Maroon JC, Abla AA. Microlumbar discectomy. Clin Neurosurg 1986; 33: 407-417
  • 6 Love JG. Removal of protuded intervertebral disks without laminectomy. Proc Staff Meet Mayo Clin 1939; 14: 800
  • 7 Goald HJ. Microlumbar discectomy: follow-up of 477 patients. J Microsurg 1980; 2 (2) 95-100
  • 8 Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine 1978; 3 (2) 175-182
  • 9 Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine 2000; 25 (12) 1515-1522
  • 10 Cox JM. Dor lombar. Chap 3. Cox JM. Neurofisiologia e patologia da raiz nervosa e do gânglio da raiz dorsal. 6th ed. São Paulo: Manole; 2002: 131-132
  • 11 Fardon DF, Milette PC. Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine 2001; 26 (5) E93-E113
  • 12 Dantas FL, Fagundes-Pereyra WJ, Rocha DL, Raso JL. Giant cervical disc herniation: case report. Arq Neuropsiquiatr 1999; 57 (2A): 296-300
  • 13 Williams RW. Microlumbar discectomy. A 12-year statistical review. Spine 1986; 11 (8) 851-852
  • 14 Hakelius A. Prognosis in sciatica. A clinical follow-up of surgical and non-surgical treatment. Acta Orthop Scand Suppl 1970; 129: 1-76
  • 15 Shapiro S. Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 1993; 32 (5) 743-746 , discussion 746–747
  • 16 Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 1968; 50 (5) 919-926
  • 17 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 1988; 13 (6) 696-706
  • 18 Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg 1995; 83 (4) 648-656
  • 19 Epstein NE, Epstein JA, Carras R, Hyman RA. Far lateral lumbar disc herniations and associated structural abnormalities. An evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management. Spine 1990; 15 (6) 534-539
  • 20 Lanzino G, Shaffrey CI, Jane JA. Surgical treatment of lateral lumbar herniated discs. In: Rengachary SS, Wilkins RH, , eds. Neurosurgical operativeatlas. Lebanon: American Assocation of Neurological Surgeons; 1999: 243-251
  • 21 Vroomen PC, de Krom MC, Wilmink JT. Pathoanatomy of clinical findings in patients with sciatica: a magnetic resonance imaging study. J Neurosurg 2000; 92 (2, Suppl): 135-141
  • 22 Ohmori K, Kanamori M, Kawaguchi Y, Ishihara H, Kimura T. Clinical features of extraforaminal lumbar disc herniation based on the radiographic location of the dorsal root ganglion. Spine 2001; 26 (6) 662-666
  • 23 Vaccaro AR, Baron EM , eds. Cirurgia da Coluna Vertebral. Rio de Janeiro: Elsevier; 2009