Kim Ju-Eun, Choi Dae-Jung
Department of Orthopedic Surgery, Andong Hospital, Andong, Korea.
Department of Spine Surgery , Barun Hospital, Jinju, Korea.
Clin Orthop Surg. 2018 Sep;10(3):328-336. doi: 10.4055/cios.2018.10.3.328. Epub 2018 Aug 22.
Open microscopic laminectomy has been the standard surgical method for degenerative spinal stenosis without instability till now. However, it is associated with complications such as paraspinal muscle injury, excessive bleeding, and wound infection. Several surgical techniques, including microendoscopic decompression, have been introduced to solve these problems.
Authors analyzed retrospectively 55 patients presenting with neurological symptoms due to degenerative lumbar spinal stenosis refractory to conservative treatment. Patients with foraminal stenosis requiring foraminal decompression were excluded. Two or three portals were used for each level. One portal was used for viewing purpose and the others for instrument passage. Unilateral laminotomy was followed by bilateral decompression under the view of 30° arthroscopy. Clinical outcomes were evaluated using modified Macnab criteria, Oswestry disability index (ODI), and visual analogue scale (VAS). Postoperative complications were checked during the 2-year follow-up. Plain radiographs before and after surgery were compared to analyze the change of disc height decrement and alignment.
ODI scores improved from 67.4 ± 11.5 preoperatively to 19.3 ± 12.1 at 2-year follow-up ( < 0.01). VAS scores of the leg decreased from 7.7 ± 1.5 to 1.7 ± 1.5 at the final follow-up ( < 0.01). Per the modified Macnab criteria, 81% of the patients improved to good/excellent. No cases of infection occurred. The intervertebral angle was significantly reduced from 6.26° ± 3.54° to 5.58° ± 3.23° at 2 years postoperatively ( = 0.027) and the dynamic intervertebral angle changed from 6.54° ± 3.71° to 6.76° ± 3.59°, which was not statistically significant ( = 0.562). No significant change in slippage was observed (3.76% ± 5.01% preoperatively vs. 3.81% ± 5.28% at the final follow-up [ = 0.531]). The dynamic percentage slip did not change significantly, from 2.65% ± 3.37% to 2.76% ± 3.71% ( = 0.985). However, intervertebral distance decreased significantly from 10.43 ± 2.23 mm to 10.0 ± 2.24 mm ( = 0.000).
Full endoscopic decompression using a 30° arthroscopy demonstrated a satisfactory clinical outcome at the 2-year follow-up. This technique reduces wound infection rate and did not bring about postoperative segmental spinal instability. It could be a feasible alternative to conventional open microscopic decompression or fusion surgery for degenerative lumbar spinal stenosis.
迄今为止，开放性显微镜下椎板切除术一直是治疗无失稳的退变性腰椎管狭窄症的标准手术方法。然而，它与诸如椎旁肌损伤、出血过多和伤口感染等并发症相关。包括显微内镜减压术在内的几种手术技术已被引入以解决这些问题。
作者回顾性分析了55例因保守治疗无效而出现神经症状的退变性腰椎管狭窄症患者。需要椎间孔减压的椎间孔狭窄患者被排除。每个节段使用两到三个通道。一个通道用于观察，其他通道用于器械通过。在30°关节镜观察下，先行单侧椎板切开术，然后进行双侧减压。使用改良Macnab标准、Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评估临床结果。在2年随访期间检查术后并发症。比较手术前后的X线平片，以分析椎间盘高度降低和对线情况的变化。
ODI评分从术前的67.4±11.5改善至2年随访时的19.3±12.1（<0.01）。末次随访时，腿部VAS评分从7.7±1.5降至1.7±1.5（<0.01）。根据改良Macnab标准，81%的患者改善为良好/优秀。未发生感染病例。术后2年时，椎间角从6.26°±3.54°显著降至5.58°±3.23°（P=0.027），动态椎间角从6.54°±3.71°变为6.76°±3.59°，差异无统计学意义（P=0.562）。滑脱未见明显变化（术前3.76%±5.01% vs. 末次随访时3.81%±5.28% [P=0.531]）。动态滑脱百分比无显著变化，从2.65%±3.37%变为2.76%±3.71%（P=0.985）。然而，椎间隙距离从10.43±2.23mm显著降至10.0±2.24mm（P=0.000）。
使用30°关节镜进行全内镜减压在2年随访时显示出令人满意的临床结果。该技术降低了伤口感染率，且未导致术后节段性脊柱失稳。对于退变性腰椎管狭窄症，它可能是传统开放性显微镜下减压或融合手术的一种可行替代方法。
