Youn Myung Soo, Shin Jong Ki, Goh Tae Sik, Lee Jung Sub
Department of Orthopaedic Surgery, Myungeun Hospital, 184 World Cup-daero, Yeonje-gu, Busan, 611-800, South Korea.
Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea.
Acta Neurochir (Wien). 2017 Jun;159(6):1129-1135. doi: 10.1007/s00701-017-3186-0. Epub 2017 Apr 22.
Several different techniques exist to treat degenerative lumbar foraminal stenosis. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, wide decompression often causes spinal instabilities or may require an additional fusion surgery. The aim of this study was to report the outcomes of endoscopic partial facetectomy (EPF) performed on patients with degenerative lumbar foraminal stenosis.
Between 2012 and 2014, 25 consecutive patients (12 women and 13 men) who underwent EPF were included in the study. The patients were assessed before surgery and followed-up regularly during outpatient visits (preoperatively and 1, 3, 6, 12, and 24 months postoperatively). The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) outcome questionnaire. The radiological outcome was measured using the lumbar Cobb angle, disc wedging angle, lumbar lordosis (LL), slip percentage, and disc height index (DHI) in plain standing radiographs.
The VAS, ODI, and SF-36 scores significantly improved at 1 month of follow-up compared with the baseline mean values and were maintained within the 2-year follow-up period. There was no radiologic progression in the lumbar Cobb's angle, disc wedging angle, LL, slip percentage, and DHI between preoperatively and 2 years postoperatively. In addition, the EPF with discectomy group and the EPF group were not significantly different in terms of clinical and radiological outcomes.
EPF is an effective option in decompressing the lumbar exiting nerve root without causing spinal instabilities for the treatment of patients with lumbar foraminal stenosis.
存在多种不同技术用于治疗退行性腰椎管狭窄症。未能充分减压腰椎椎间孔可能导致腰椎手术失败综合征。然而，广泛减压常导致脊柱不稳定或可能需要额外的融合手术。本研究的目的是报告对退行性腰椎管狭窄症患者进行内镜下部分关节突切除术（EPF）的结果。
2012年至2014年期间，连续25例接受EPF的患者（12例女性和13例男性）纳入本研究。在手术前对患者进行评估，并在门诊定期随访（术前以及术后1、3、6、12和24个月）。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和简明健康调查36项量表（SF-36）结果问卷评估临床结果。在站立位平片上使用腰椎Cobb角、椎间盘楔变角、腰椎前凸（LL）、滑脱百分比和椎间盘高度指数（DHI）测量放射学结果。
与基线平均值相比，随访1个月时VAS、ODI和SF-36评分显著改善，并在2年随访期内保持。术前与术后2年之间，腰椎Cobb角、椎间盘楔变角、LL、滑脱百分比和DHI无放射学进展。此外，EPF联合椎间盘切除术组和EPF组在临床和放射学结果方面无显著差异。
对于腰椎管狭窄症患者的治疗，EPF是一种有效的减压腰椎出口神经根且不引起脊柱不稳定的选择。
