Maugeri Rosario, Basile Luigi, Gulì Carlo, Banco Aurelia, Giordano Giovanna, Giugno Antonella, Graziano Francesca, Giammalva Roberto Giuseppe, Iacopino Domenico Gerardo
Department of Neurosurgery, Università Degli Studi di Palermo, Palermo, Italy.
Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy.
J Neurol Surg A Cent Eur Neurosurg. 2018 Sep;79(5):365-371. doi: 10.1055/s-0038-1641148. Epub 2018 Jun 14.
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS.
This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pedicle-lengthening osteotomy using the ALTUM system ((Innovative Surgical Designs, Inc., Bloomington, Indiana, United States). Peri- and postoperative demographic and radiographic data were collected from a clinical series of seven patients with moderate LSS who were > 60 years of age. Clinical outcome was evaluated using visual analog scale (VAS) scores and the spinal canal area on computed tomography scans.
Twelve months after the procedure, scoring revealed a median improvement of 3.7 on the VAS for the back and 6.3 on the VAS for the leg, compared with the preoperative baseline ( < 0.05). The postoperative central area of the lumbar canal was significantly increased, by 0.39 cm; the right and left neural foramina were enlarged by 0.29 cm and 0.47 cm, respectively ( < 0.05).
In this preliminary study, the ALTUM system showed a good clinical and radiologic outcome 1 year after surgery. In an older or high-risk population, a short minimally invasive procedure may be beneficial for treating LSS.
腰椎管狭窄症（LSS）是由于脊柱退变导致的椎管狭窄，其主要临床症状是神经源性间歇性跛行。对于经保守治疗无改善的患者可采用手术治疗。有症状的LSS患者若同时伴有严重的内科合并症，尽管显然需要干预，但对于传统的开放性腰椎减压手术来说并非理想的候选者。因此，探索微创外科技术来治疗特定的LSS患者很重要。
本回顾性病例系列评估了一种治疗LSS的新型微创手术的临床和影像学结果：使用ALTUM系统（美国印第安纳州布卢明顿市创新外科设计公司）进行椎弓根延长截骨术。收集了7例年龄>60岁的中度LSS患者临床系列的围手术期和术后人口统计学及影像学数据。使用视觉模拟量表（VAS）评分和计算机断层扫描上的椎管面积评估临床结果。
术后12个月，评分显示与术前基线相比，背部VAS评分中位数改善3.7，腿部VAS评分中位数改善6.3（P<0.05）。腰椎管的术后中央区域显著增加，增加了0.39平方厘米；右侧和左侧神经孔分别扩大了0.29平方厘米和0.47平方厘米（P<0.05）。
在这项初步研究中，ALTUM系统在术后1年显示出良好的临床和影像学结果。在老年或高危人群中，简短的微创手术可能有利于治疗LSS。
