McGrath Lynn B, White-Dzuro Gabrielle A, Hofstetter Christoph P
J Neurosurg Spine. 2019 Jan 11;30(4):491-499. doi: 10.3171/2018.9.SPINE18689. Print 2019 Apr 1.
Minimally invasive lumbar unilateral tubular laminotomy for bilateral decompression has gradually gained acceptance as a less destabilizing but efficacious and safe alternative to traditional open decompression techniques. The authors have further advanced the principles of minimally invasive surgery (MIS) by utilizing working-channel endoscope-based techniques. Full-endoscopic technique allows for high-resolution off-axis visualization of neural structures within the lateral recess, thereby minimizing the need for facet joint resection. The relative efficacy and safety of MIS and full-endoscopic techniques have not been directly compared.
A retrospective analysis of 95 consecutive patients undergoing either MIS (n = 45) or endoscopic (n = 50) unilateral laminotomies for bilateral decompression in cases of lumbar spinal stenosis was performed. Patient demographics, operative details, clinical outcomes, and complications were reviewed.
The patient cohort consisted of 41 female and 54 male patients whose average age was 62 years. Half of the patients had single-level, one-third had 2-level, and the remaining patients had 3- or 4-level procedures. The surgical time for endoscopic technique was significantly longer per level compared to MIS (161.8 ± 6.8 minutes vs 99.3 ± 4.6 minutes; p < 0.001). Hospital stay for MIS patients was on average 2.4 ± 0.5 days compared to 0.7 ± 0.1 days for endoscopic patients (p = 0.001). At the 1-year follow-up, endoscopic patients had a significantly lower visual analog scale score for leg pain than MIS patients (1.3 ± 0.3 vs 3.0 ± 0.5; p < 0.01). Moreover, the back pain disability index score was significantly lower in the endoscopic cohort than in the MIS cohort (20.7 ± 3.4 vs 35.9 ± 4.1; p < 0.01). Two patients in the MIS group (epidural hematoma) and one patient in the endoscopic group (disc herniation) required a return to the operating room acutely after surgery (< 14 days).
Lumbar endoscopic unilateral laminotomy for bilateral decompression is a safe and effective surgical procedure with favorable complication profile and patient outcomes.
微创腰椎单侧管状椎板切开双侧减压术作为一种比传统开放减压技术更稳定且有效、安全的替代方法，已逐渐被接受。作者通过运用基于工作通道内镜的技术进一步推进了微创手术（MIS）的原则。全内镜技术可对侧隐窝内的神经结构进行高分辨率偏轴可视化，从而最大限度减少小关节突切除的需求。MIS和全内镜技术的相对疗效及安全性尚未得到直接比较。
对95例因腰椎管狭窄症接受MIS（n = 45）或内镜（n = 50）单侧椎板切开双侧减压术的连续患者进行回顾性分析。回顾患者的人口统计学资料、手术细节、临床结果及并发症情况。
患者队列包括41例女性和54例男性患者，平均年龄为62岁。一半患者为单节段手术，三分之一为双节段手术，其余患者为三节段或四节段手术。与MIS相比，内镜技术每节段的手术时间显著更长（161.8 ± 6.8分钟对99.3 ± 4.6分钟；p < 0.001）。MIS患者的平均住院时间为2.4 ± 0.5天，而内镜手术患者为0.7 ± 0.1天（p = 0.001）。在1年随访时，内镜手术患者腿痛的视觉模拟评分显著低于MIS患者（1.3 ± 0.3对3.0 ± 0.5；p < 0.01）。此外，内镜组的背痛残疾指数评分显著低于MIS组（20.7 ± 3.4对35.9 ± 4.1；p < 0.01）。MIS组有2例患者（硬膜外血肿）和内镜组有1例患者（椎间盘突出）术后需急诊返回手术室（< 14天）。
腰椎内镜单侧椎板切开双侧减压术是一种安全有效的手术方法，具有良好的并发症情况和患者预后。
