Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea.
World Neurosurg. 2019 Oct;130:e1070-e1076. doi: 10.1016/j.wneu.2019.07.087. Epub 2019 Jul 16.
Postlaminectomy syndrome (PLS) or failed back surgery syndrome is a condition characterized by persistent pain following a back surgery. Degenerative processes may result in foraminal stenosis development over time, even after a successful surgery. Percutaneous endoscopic lumbar foraminotomy (PELF) offers a minimally invasive means of treating foraminal stenosis after a back surgery. The objective of this study was to evaluate the outcomes of PELF for foraminal stenosis with PLS in geriatric patients.
Two-year follow-up data were collected from 21 consecutive patients aged 65 years or older (mean age, 72.4 years) who underwent PELF for foraminal stenosis with PLS. Transforaminal endoscopic foraminal decompression was performed under local anesthesia. Outcomes were assessed using visual analog scale pain score, Oswestry Disability Index, and modified Macnab criteria.
Mean visual analog scale for leg pain improved from 8.48 at baseline to 3.33 at 6 weeks, 2.10 at 1 year, and 2.19 at 2 years after PELF (P < 0.01). Mean Oswestry Disability Index improved from 67.29 at baseline to 30.69 at 6 weeks, 22.50 at 1 year, and 20.81 at 2 years after PELF (P < 0.01). Based on the modified Macnab criteria, excellent or good results were obtained in 81.0% of patients and symptomatic improvements were obtained in 95.2% of patients.
The transforaminal endoscopic approach can provide a better access angle to achieve a sophisticated foraminal decompression with less facet and dural injury. Therefore, PELF under local anesthesia can be useful for PLS or postoperative foraminal stenosis in elderly patients.
脊术后综合征（Postlaminectomy syndrome，PLS）或失败的脊柱手术综合征是一种在脊柱手术后持续疼痛的病症。退行性过程可能导致椎间孔狭窄随时间的推移而发展，即使在成功手术后也是如此。经皮内窥镜腰椎椎间孔切开术（Percutaneous endoscopic lumbar foraminotomy，PELF）为脊柱手术后椎间孔狭窄提供了一种微创治疗方法。本研究的目的是评估 PELF 治疗老年患者 PLS 伴脊术后椎间孔狭窄的疗效。
收集了 21 例年龄在 65 岁及以上（平均年龄 72.4 岁）的连续患者的 2 年随访数据，这些患者因 PLS 伴脊术后椎间孔狭窄接受了 PELF 治疗。在局部麻醉下进行经椎间孔内窥镜椎间孔减压术。使用视觉模拟评分法（visual analog scale，VAS）疼痛评分、Oswestry 残疾指数（Oswestry Disability Index，ODI）和改良 Macnab 标准评估结果。
腿部疼痛的 VAS 平均值从基线时的 8.48 分改善至 PELF 后 6 周时的 3.33 分、1 年时的 2.10 分和 2 年时的 2.19 分（P < 0.01）。ODI 平均值从基线时的 67.29 分改善至 PELF 后 6 周时的 30.69 分、1 年时的 22.50 分和 2 年时的 20.81 分（P < 0.01）。根据改良 Macnab 标准，81.0%的患者获得了优秀或良好的结果，95.2%的患者获得了症状改善。
经椎间孔内窥镜入路可以提供更好的进入角度，以实现更精细的椎间孔减压，减少小关节和硬脊膜损伤。因此，局部麻醉下的 PELF 对于老年患者的 PLS 或术后椎间孔狭窄可能是有用的。
