Yagi Mitsuru, Okada Eijiro, Ninomiya Ken, Kihara Michiya
Department of Orthopedic Surgery, Kawasaki Municipal Hospital, Kawasaki City, Japan.
J Neurosurg Spine. 2009 Apr;10(4):293-9. doi: 10.3171/2009.1.SPINE08288.
The object of this study was to assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique to correct degenerative lumbar spinal stenosis involving a modified unilateral-approach microendoscopic midline decompression.
In this prospective study, 41 patients with lumbar stenosis were randomly assigned to undergo either a novel, median-approach microendoscopic laminectomy (20 patients) or a conventional laminectomy (21 patients). Spinal anteroposterior diameter, cross-sectional area, lateral recess distance, spinal stability, postoperative back pain, functional outcomes, and muscle trauma were evaluated. Follow-up ranged from 16 to 24 months, with a mean of 17.8 months for the novel procedure group and 18.6 months for the conventional laminectomy group.
Compared with patients in the conventional laminectomy group, patients who received the novel procedure had a reduced mean duration of hospital stay, a lower mean creatine phosphokinase muscular-type isoenzyme level, a lower visual analog scale score for back pain at 1-year follow-up, and a faster recovery rate. These patients also had less mean blood loss compared with the conventionally treated group. Satisfactory neurological decompression and symptom relief were achieved in 90% of these patients. There was no significant clinical difference compared with the conventional laminectomy group's results. There was no evidence of spinal instability in any patient, and no patient required a follow-up conventional laminectomy.
This novel procedure provides effective spinal decompression. Although this method requires more operating time than a conventional method, it requires only minimal muscle trauma and spinal stability maintenance, and allows for early mobilization. This shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory neurological and functional outcomes. Moreover, with the midline approach, decompression was accomplished without compromising the facet joints, even with a narrow width of lamina.
本研究旨在评估一种新型微创脊柱手术技术治疗退变性腰椎管狭窄症的可行性和疗效，该技术采用改良单侧入路显微内镜下中线减压术。
在这项前瞻性研究中，41例腰椎管狭窄症患者被随机分为两组，分别接受新型中线入路显微内镜下椎板切除术（20例）或传统椎板切除术（21例）。评估脊柱前后径、横截面积、侧隐窝距离、脊柱稳定性、术后背痛、功能结局和肌肉损伤情况。随访时间为16至24个月，新型手术组平均随访时间为17.8个月，传统椎板切除术组为18.6个月。
与传统椎板切除术组患者相比，接受新型手术的患者平均住院时间缩短，平均肌酸磷酸激酶肌肉型同工酶水平降低，1年随访时背痛的视觉模拟评分更低，恢复速度更快。与传统治疗组相比，这些患者的平均失血量也更少。90%的患者实现了满意的神经减压和症状缓解。与传统椎板切除术组的结果相比，无显著临床差异。所有患者均无脊柱不稳定的证据，也没有患者需要进行后续的传统椎板切除术。
这种新型手术可提供有效的脊柱减压。虽然该方法比传统方法需要更多的手术时间，但仅需最小程度的肌肉损伤并能维持脊柱稳定性，且允许早期活动。这缩短了住院时间，减轻了术后背痛，并带来了满意的神经和功能结局。此外，采用中线入路，即使在椎板宽度较窄的情况下，减压也不会影响小关节。
