内視鏡による腰椎後方手術（MED）の基本と応用

Surgical Procedure and Indication of Microendoscopic Discectomy

Point

・内視鏡による腰椎椎間板ヘルニアの基本的手技とその応用を解説した．

・内視鏡の適応については慎重な検討が必要である．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Standard microscopic posterior decompression（MD）for lumbar disc herniation has been well established and is a familiar procedure to virtually all spinal neurosurgeons. Traditional surgical treatments are often associated with severe postoperative pain, disability, and dysfunction. This study aimed to describe the microendoscopic discectomy（MED）technique for lumbar disc herniation and report its surgical indications. This technique has been shown to provide symptomatic relief equivalent to that of microdiscectomy, with obvious reductions in operative hospital stay and narcotic use. No significant differences in outcome data between the two groups were observed. However, several patients in the MED group required surgical conversion to MD. The size of the disc herniation was the most important factor in the conversion. MED is an effective microendoscopic system with good long-term outcomes for the treatment of lumbar disc herniation. The endoscopic approach allows for smaller incisions and less tissue trauma than the standard open microdiscectomy. Strict adherence to well-defined preoperative selection criteria ensures optimal postoperative outcomes.