Department of Neurosurgery, Seoul National University Hospital, Seoul, the Republic of Korea.
National Evidence Based Healthcare Collaborating Agency (NECA), Seoul, the Republic of Korea.
Spine (Phila Pa 1976). 2018 Dec 15;43(24):1756-1764. doi: 10.1097/BRS.0000000000002708.
A meta-analysis of five retrospective cohort studies.
The aim of the study was to delineate the efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine using a meta-analysis.
The paradigm of spinal endoscopy is shifting from treatment of soft disc herniation to that of lumbar spinal stenosis. Technical advancements have enabled full-endoscopic decompression in spinal stenosis surgery. There is few strong evidence supporting this surgical technique, and clinicians usually rely on their own opinions and experiences.
A systematic search of electronic databases, including PubMed, EMBASE, Cochrane Library, Web of science, and KoreaMed, up to August 2017 was performed to identify studies concerning full-endoscopic decompression via the interlaminar approach for lumbar spinal stenosis. Changes in clinical outcomes [Oswestry Disability Index (ODI) and Visual Analog Scales (VAS) for back and leg pain] were compared with the minimal clinically important difference (MCID) for each item. We then calculated the mean differences and 95% confidence intervals (95% CIs) using random-effects models.
We included data from five studies involving 156 patients at 6- and 12-month follow-ups. The majority of enrolled papers included patients with neurogenic claudication due to central stenosis refractory to conservative management and excluded patients with significant instability or previous surgery. The overall mean difference of patients with ODI and VAS scores for leg and back pain exceeded the criteria for MCID. ODI scores improved by 41.71 (95% CI, 39.80-43.62) after the surgery, which was twice the MCID. The VAS leg and back pain scores improved by 5.95 (95% CI, 5.70-6.21) and 4.22 (95% CI, 3.88-4.56), respectively, indicating statistically significant improvement over the MCID.
Successful clinical outcomes can be achieved with full-endoscopic decompression via the interlaminar approach for lumbar central spinal stenosis in patients for the defined indications.
五项回顾性队列研究的荟萃分析。
本研究旨在通过荟萃分析阐明全内镜经椎间孔入路治疗腰椎中央或侧隐窝狭窄的疗效和安全性。
脊柱内镜的治疗模式正从治疗软性椎间盘突出症转变为治疗腰椎管狭窄症。技术进步使全内镜减压在椎管狭窄手术中成为可能。目前几乎没有强有力的证据支持这种手术技术，临床医生通常依赖于自己的意见和经验。
系统检索电子数据库，包括 PubMed、EMBASE、Cochrane 图书馆、Web of science 和 KoreaMed，检索时间截至 2017 年 8 月，以确定关于全内镜经椎间孔入路治疗腰椎管狭窄症的研究。通过与每个项目的最小临床重要差异（MCID）进行比较，比较临床结果（Oswestry 残疾指数（ODI）和背部及腿部疼痛的视觉模拟量表（VAS））的变化。然后使用随机效应模型计算平均值差异和 95%置信区间（95%CI）。
我们纳入了五项研究的数据，这些研究共纳入了 156 例患者，随访时间为 6 个月和 12 个月。纳入的大多数论文都包括因中央狭窄导致的神经源性跛行患者，这些患者对保守治疗无效，且排除了有明显不稳定或既往手术的患者。ODI 和 VAS 评分的患者腿部和背部疼痛的总体平均差异超过了 MCID 标准。术后 ODI 评分改善了 41.71（95%CI，39.80-43.62），是 MCID 的两倍。VAS 腿部和背部疼痛评分分别改善了 5.95（95%CI，5.70-6.21）和 4.22（95%CI，3.88-4.56），表明与 MCID 相比有统计学上的显著改善。
对于明确适应证的腰椎中央椎管狭窄症患者，全内镜经椎间孔入路减压可获得满意的临床效果。
2 级。
