Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts 02118, USA.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):152-60. doi: 10.1227/01.NEU.0000365826.15986.40.
To evaluate the efficacy of the transspinous approach compared with the conventional approach in single-level lumbar laminotomies with and without discectomies.
Forty consecutive patients underwent single-level lumbar decompression with or without a discectomy. The first 20 patients underwent surgery by the conventional approach (11 with discectomy and 9 without), and the transspinous approach was used in the remaining 20 patients (11 with discectomy and 9 without). Results between the groups were assessed by comparing the following measures: length of inpatient hospital stay, postoperative pain and analgesia use, estimated blood loss, rate of postoperative disability and complications, and incision length.
The groups did not differ significantly with respect to age, level of pathology, insurance status, or type of analgesia used. The primary outcome was physical disability, measured using the Roland-Morris Disability Questionnaire. The secondary outcome was pain intensity, measured using the Brief Pain Inventory. Patients who underwent the transspinous approach had better outcomes across all measures with significance appreciated in those who underwent transspinous decompression with discectomies. Other statistically significant differences were identified in incision length and postoperative analgesia use at the end of 1 week. No statistically significant differences were identified in the rates of complications, estimated blood loss, inpatient narcotic analgesia use, or length of inpatient hospital stay.
Patients who underwent single-level lumbar decompression with or without discectomy had similar outcomes as those who underwent the conventional approach. Although of modest clinical significance, the transspinous approach may afford early mobilization and reduced postoperative pain while providing a satisfactory neurological and functional outcome.
评估经皮椎弓根入路与传统入路在单纯减压与减压联合椎间盘切除的单节段腰椎板切开术中的疗效。
40 例连续患者接受了单节段腰椎减压术，其中 20 例行传统入路（11 例椎间盘切除，9 例无椎间盘切除），20 例行经皮椎弓根入路（11 例椎间盘切除，9 例无椎间盘切除）。通过比较以下指标评估两组间的结果：住院时间、术后疼痛和镇痛使用、估计失血量、术后残疾和并发症发生率、切口长度。
两组在年龄、病变水平、保险状况或使用的镇痛类型方面无显著差异。主要结果是身体残疾，采用 Roland-Morris 残疾问卷进行测量。次要结果是疼痛强度，采用简短疼痛量表进行测量。接受经皮椎弓根入路的患者在所有指标上的结果都更好，在接受经皮椎弓根减压联合椎间盘切除的患者中更明显。在切口长度和术后 1 周结束时的术后镇痛使用方面还发现了其他具有统计学意义的差异。在并发症发生率、估计失血量、住院阿片类药物使用或住院时间方面未发现统计学显著差异。
接受单纯减压或减压联合椎间盘切除的单节段腰椎减压术的患者与接受传统入路的患者具有相似的结果。尽管具有适度的临床意义，但经皮椎弓根入路可能提供早期活动和减轻术后疼痛，同时提供令人满意的神经和功能结果。
