Li Zhen-zhou, Hou Shu-xun, Shang Wei-lin, Cao Zheng, Zhao Hong-liang
The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
Clin Neurol Neurosurg. 2016 Apr;143:90-4. doi: 10.1016/j.clineuro.2016.02.008. Epub 2016 Feb 10.
To evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs).
From August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1-100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria.
Two years follow-up data were obtained from 85 cases, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5S1, 1 case on bilateral L5S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4-S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46-78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given "excellent"; 48 were given "good". 6 patients experienced heavier low back pain, thus being classified as "fair". 2 cases with recurrence were given "poor".
PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs.
评估经皮腰椎椎间孔成形术（PLF）和经皮内镜下腰椎减压术（PELD）使用专门设计的器械治疗伴有或不伴有椎间盘突出（HD）的腰椎侧隐窝狭窄症的疗效及安全性。
2011年8月至2013年8月，96例符合纳入标准的患者接受了PLF-PELD治疗，85例患者术后随访2年。术后次日晨进行MRI或CT检查。术后3个月、6个月、1年和2年通过随访访谈评估症状转归。采用视觉模拟评分（VAS）（1-100）评估腰痛和腿痛。使用Oswestry功能障碍指数（ODI）和改良MacNab标准评估功能转归。
85例患者获得了2年随访数据，其中单侧L3-4节段14例，双侧L3-4节段1例，单侧L4-5节段49例，双侧L4-5节段3例，单侧L5S1节段12例，双侧L5S1节段1例，单侧L3-5节段3例，单侧L4-S1节段2例。共减压95个腰椎侧隐窝。患者年龄46-78岁（平均年龄56.7岁），男性36例，女性49例。56例合并HD。所有患者术后腰痛和腿痛均明显缓解。3例患者出现患侧神经分布区感觉异常，均为L5S1节段手术。术后MRI/CT检查显示所有患者侧隐窝减压充分，合并的HD均被摘除。无患者发生术后感染、神经根功能障碍损伤或医源性节段性不稳。2例患者合并HD复发（2.4%），但因身体状况差无法进行进一步翻修手术。85例患者均有完整随访资料并进行分析。术后各时间点VAS评分和ODI值均显著低于术前。85例患者均获得术后2年MacNab评分。29例为“优”；48例为“良”。6例患者腰痛加重，评定为“可”。2例复发患者评定为“差”。
使用专门设计的器械进行PLF-PELD治疗伴有或不伴有合并HD的腰椎侧隐窝狭窄症是一种微创、有效且安全的手术。
