Mlyavykh Sergey, Ludwig Steven C, Kepler Christopher K, Anderson D Greg
1Privolzhski Federal Medical Research Center, Nizhniy Novgorod, Russia.
2Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland; and.
J Neurosurg Spine. 2018 Sep;29(3):241-249. doi: 10.3171/2017.11.SPINE16664. Epub 2018 Jun 1.
OBJECTIVE Lumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic options have certain drawbacks. This study evaluates the 5-year clinical and radiographic results of a minimally invasive pedicle-lengthening osteotomy (PLO) for symptomatic LSS. METHODS A prospective, single-arm, clinical pilot study was conducted involving 20 patients (mean age 61.7 years) with symptomatic LSS treated by a PLO procedure at 1 or 2 lumbar levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS, and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index, Zürich Claudication Questionnaire, 12-Item Short Form Health Survey, and a visual analog scale for back and leg pain. Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, 12-, 24-, and 60-month time points. RESULTS The PLOs were performed through percutaneous incisions, with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Statistically significant improvement was observed in each of the outcome instruments and maintained over the 5-year follow-up period. Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT scans documented healing of the osteotomy site in all patients at the 6-month time point and an increase of 115% in the mean cross-sectional area of the spinal canal. CONCLUSIONS Treatment of patients with symptomatic LSS with a PLO procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non-disease-specific outcome measures at all follow-up time points out to 5 years. Future research is needed to compare this technique to alternative therapies for LSS.
目的 腰椎管狭窄症（LSS）是一种常见疾病，会导致严重残疾，在老年人中尤为如此。目前的治疗选择存在一定缺陷。本研究评估了用于有症状LSS的微创椎弓根延长截骨术（PLO）的5年临床和影像学结果。方法 进行了一项前瞻性、单臂临床试点研究，纳入20例（平均年龄61.7岁）有症状LSS患者，在1或2个腰椎节段接受PLO手术治疗。所有患者均有继发于LSS的神经源性间歇性跛行或神经根病症状，且经过至少6个月的非手术治疗后症状未改善。11例患者除LSS外还伴有迈耶丁I级退变性腰椎滑脱。使用奥斯威斯利功能障碍指数、苏黎世间歇性跛行问卷、12项简短健康调查问卷以及背部和腿部疼痛视觉模拟量表来测量临床结果。在1.5、3、6、9、12、24和60个月时间点收集手术变量、神经学结果、不良事件和放射学影像（平片和CT扫描）。结果 PLO手术通过经皮切口进行，所有病例失血极少。无手术并发症。随访期间发生4例不良事件。在各结果指标上均观察到有统计学意义的改善，且在5年随访期内持续存在。由独立放射科医生复查的影像学研究显示，无器械下沉、移位、断裂或异位骨化的证据。薄层CT扫描记录了所有患者在6个月时间点截骨部位的愈合情况，以及椎管平均横截面积增加了115%。结论 采用PLO手术治疗有症状LSS患者，在长达5年的所有随访时间点，椎管面积均有显著扩大，在疾病特异性和非疾病特异性结果指标方面均取得了良好的临床效果。未来需要开展研究，将该技术与LSS的其他治疗方法进行比较。
