Podichetty Vinod K, Spears John, Isaacs Robert E, Booher John, Biscup Robert S
Spine Research and Education, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
J Spinal Disord Tech. 2006 May;19(3):161-6. doi: 10.1097/01.bsd.0000188663.46391.73.
Surgical strategies for the decompression of lumbar spinal stenosis have evolved to include minimally invasive techniques providing for adequate and safe decompression while reducing perioperative morbidity. Retrospective case series analysis of 220 consecutive patients with lumbar spinal stenosis who underwent microscopic or microendoscopic minimally invasive decompression was performed. The objective was to evaluate the risks associated with performing a minimally invasive decompression for spinal stenosis in a large group of patients.
Two hundred twenty patients with symptomatic neurogenic claudication from lumbar spinal stenosis failing nonoperative treatment received a minimally invasive decompression surgery. Intraoperative data, postoperative data through hospital discharge, and clinical follow-up were analyzed.
The average age was 74.2 years (range 49-98 years). There were 379 spinal levels decompressed in 220 patients. Sixty-nine patients (31.4%) had a grade 1 degenerative spondylolisthesis. One hundred sixty-eight patients (76%) received spinal anesthesia, and 52 received general anesthesia. Eighty-seven patients (40%) had a preoperative American Society of Anesthesiologists score of 3 or 4. Average operative blood loss was 92 mL. There were 17 intraoperative durotomies (4.5% rate). The average length of stay before discharge was 1.2 days. Ten patients went to inpatient rehabilitation at discharge. One hundred ninety-four patients (88.2%) were discharged within 24 hours. There were five readmissions within the first month after discharge, four of those for medical complications. There were 24 minor complications and 14 major complications. Forty-two patients (19%) took no oral or parenteral narcotic pain medications in the postanesthesia to discharge period.
Minimally invasive decompression strategies for spinal stenosis seem consistently to result in short hospital lengths of stay, minimal requirements for narcotic pain medications, and a low rate of readmission and complications.
腰椎管狭窄减压手术策略已发展至包括微创技术，该技术可在减少围手术期发病率的同时实现充分且安全的减压。对220例连续接受显微镜或微内镜下微创减压的腰椎管狭窄患者进行了回顾性病例系列分析。目的是评估在一大群患者中进行腰椎管狭窄微创减压的相关风险。
220例因腰椎管狭窄导致症状性神经源性间歇性跛行且非手术治疗失败的患者接受了微创减压手术。分析了术中数据、出院前的术后数据以及临床随访情况。
平均年龄为74.2岁（范围49 - 98岁）。220例患者共减压379个脊柱节段。69例患者（31.4%）有1级退变性腰椎滑脱。168例患者（76%）接受了脊髓麻醉，52例接受了全身麻醉。87例患者（40%）术前美国麻醉医师协会评分为3或4分。平均术中失血量为92毫升。有17例术中硬脊膜切开（发生率4.5%）。出院前平均住院时间为1.2天。10例患者出院后前往住院康复机构。194例患者（88.2%）在24小时内出院。出院后第一个月内有5例再次入院，其中4例是因医疗并发症。有24例轻微并发症和14例严重并发症。42例患者（19%）在麻醉后至出院期间未服用口服或胃肠外麻醉性镇痛药。
腰椎管狭窄的微创减压策略似乎始终能带来较短的住院时间、对麻醉性镇痛药的最低需求以及较低的再入院率和并发症发生率。
