Li Xin-Feng, Jin Lin-Yu, Lv Zhen-Dong, Su Xin-Jin, Wang Kun, Song Xiao-Xing, Shen Hong-Xing
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
World Neurosurg. 2019 Jun;126:e517-e525. doi: 10.1016/j.wneu.2019.02.083. Epub 2019 Feb 28.
Decompression alone is a treatment option in patients with lumbar spinal stenosis (LSS) and degenerative lumbar spondylolisthesis (DLS). This study aims to describe the procedure of percutaneous transforaminal endoscopic ventral decompression technique and to demonstrate the clinical outcomes.
Two years of retrospective data were collected from 26 patients with predominant unilateral leg pain caused by LSS and low-grade DLS (Meyerding grades I and Ⅱ). All patients underwent endoscopic ventral decompression by removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression without excessive resection of facet joints. The surgical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, and walking distance improvement evaluation.
The mean age of the 18 women and 8 men was 69.2 years. The mean preoperative ODI and VAS of the leg and the back scores were 64.7 ± 8.1, 7.0 ± 1.4, and 3.0 ± 1.2, respectively. All mean scores improved postoperatively to 31.4 ± 5.6, 2.4 ± 1.1, and 1.7 ± 1.1 at the final follow-up. In 88.5% of cases, patients' estimated walking distance improved. The outcomes of the modified MacNab criteria showed that 81.3% of patients obtained good-to-excellent rate. There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of follow-up.
Based on the initial short-term follow-up results, transforaminal endoscopic ventral decompression by partially removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression, might be an efficient alternative treatment for leg dominant symptoms in patients with LSS and low-grade DLS.
单纯减压是腰椎管狭窄症（LSS）和退变性腰椎滑脱症（DLS）患者的一种治疗选择。本研究旨在描述经皮椎间孔内镜下前路减压技术的操作过程并展示其临床疗效。
收集了26例因LSS和低度DLS（Meyerding分级I级和II级）导致以单侧腿痛为主的患者的两年回顾性数据。所有患者均接受内镜下前路减压，通过切除滑脱椎体下方的后上缘，并结合后路减压，且不进行过度的关节突关节切除。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、改良MacNab标准和步行距离改善评估来评估手术效果。
18名女性和8名男性的平均年龄为69.2岁。术前腿部和背部的平均ODI及VAS评分分别为64.7±8.1、7.0±1.4和3.0±1.2。在最后一次随访时，所有平均评分术后均改善至31.4±5.6、2.4±1.1和1.7±1.1。在88.5%的病例中，患者的估计步行距离有所改善。改良MacNab标准的结果显示，81.3%的患者获得了良好至优秀的比率。手术前和随访结束时腰椎滑脱的滑移百分比之间无统计学显著差异。
基于最初的短期随访结果，通过部分切除滑脱椎体下方的后上缘并结合后路减压进行椎间孔内镜下前路减压，可能是LSS和低度DLS患者以腿部症状为主时的一种有效替代治疗方法。
