Shen Jian
Mohawk Valley Orthopedics, Amsterdam, New York, USA; Center for Spine Regeneration Surgery, New York, New York, USA.
World Neurosurg. 2019 Jul;127:e745-e750. doi: 10.1016/j.wneu.2019.03.257. Epub 2019 Apr 2.
To evaluate clinical outcomes of a case series of 18 patients who underwent fully endoscopic foraminotomy, laminectomy, and transforaminal lumbar interbody fusion combined with percutaneous screw fixation.
This was a retrospective case series of a single surgeon. Average age of patients was 66 years (range, 51-82 years). All patients had grade I or grade II spondylolisthesis and severe central canal stenosis. Patients underwent endoscopic transforaminal access through Kambin triangle for foraminotomy, discectomy, endplate preparation, and interbody fusion, which was followed by fully endoscopic unilateral laminectomy and bilateral decompression and percutaneous pedicle screw and connecting rod placement.
All procedures were successful without conversion to open surgery. Mean operative time was 168 minutes, and average estimated blood loss was 36 mL. Mean length of hospital stay was 1.2 days. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that average Oswestry Disability Index score improved from 48 ± 14 (range, 37-61) to 13 ± 11 (range, 0-27) (P < 0.001). Average visual analog scale back pain score improved from 8.1 ± 2.0 (range, 6.8-10.0) to 1.8 ± 0.9 (range, 0.0-3.5) (P < 0.001). Oswestry Disability Index and visual analog scale back pain scores at last follow-up showed 73% and 78% improvement, respectively, from the preoperative period. There were no cases of nonunion clinically or radiographically on final follow-up of >12 months.
Fully endoscopic laminectomy and interbody fusion under conscious sedation is an effective treatment with minimal complications for patients with lumbar spondylolisthesis and severe spinal stenosis.
评估18例行全内镜下椎间孔切开术、椎板切除术、经椎间孔腰椎椎间融合术联合经皮螺钉固定术患者的临床疗效。
这是一项针对单一外科医生的回顾性病例系列研究。患者平均年龄66岁（范围51 - 82岁）。所有患者均有Ⅰ级或Ⅱ级椎体滑脱及严重的中央管狭窄。患者经Kambin三角行内镜下经椎间孔入路进行椎间孔切开术、椎间盘切除术、终板准备及椎间融合术，随后进行全内镜下单侧椎板切除术及双侧减压，并置入经皮椎弓根螺钉及连接棒。
所有手术均成功，无需转为开放手术。平均手术时间为168分钟，平均估计失血量为36毫升。平均住院时间为1.2天。无术中或术后并发症。术前与最终临床指标比较显示，平均Oswestry功能障碍指数评分从48±14（范围37 - 61）改善至13±11（范围0 - 27）（P < 0.001）。平均视觉模拟量表背痛评分从8.1±2.0（范围6.8 - 10.0）改善至1.8±0.9（范围0.0 - 3.5）（P < 0.001）。末次随访时，Oswestry功能障碍指数和视觉模拟量表背痛评分较术前分别改善了73%和78%。在超过12个月的最终随访中，临床及影像学上均无骨不连病例。
清醒镇静下的全内镜椎板切除术和椎间融合术是治疗腰椎椎体滑脱和严重椎管狭窄患者的一种有效方法且并发症极少。
