Cao Shiqi, Cui Hongpeng, Lu Zhengcao, Zhu Kai, Fu Bensheng, Li Wen, Zhang Jianjun, Ding Yu
Department of Rehabilitation, Minimally Invasive Spine Center, 6th Medical Center, PLA General Hospital, Beijing, People's Republic of China.
Medicine (Baltimore). 2019 Aug;98(35):e17021. doi: 10.1097/MD.0000000000017021.
To describe the Tube in Tube interlaminar endoscopic decompression method and investigate its efficacy and safety in treating lumbar spinal stenosis (LSS).Utilizing the advantages of the micro-endoscopic decompression (MED) operation channel tube, we used a water-medium spinal endoscopy to perform trans-interlaminar canal decompression, that is, the "Tube in Tube" technique. A retrospective study was performed on 35 patients with LSS who were treated with the Tube in Tube technique. All patients were followed up to 12 months postoperatively. Visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were collected preoperatively and at 3, 6, and 12 months postoperatively. Short-form (36) health survey (SF-36) score was used to examine the general health-related quality of life (HRQoL) of patients preoperatively and at 3 and 12 months postoperatively. Modified Macnab criteria were used to examine the clinical outcomes at 3 and 12 months post-surgery.The clinical outcomes were satisfactory, with an improvement in all scoring systems. The VAS, JOA, and ODI scores improved from 6.46 ± 1.85, 12.03 ± 4.96, and 42.17 ± 12.22 preoperatively to 2.20 ± 1.14, 21.40 ± 5.86, and 13.14 ± 7.52 at 12 months postoperatively, respectively (P < .001). The Macnab excellent or good rates reached 65.7% and 77.1% at the 3 and 12 months follow-ups. No severe complications occurred.The Tube in Tube technique had a positive clinical outcome in LSS patients and is safe, reliable, and efficacious. However, a larger number of cases and a multi-center research design will be needed further develop the technique.Level of Evidence: IV.
描述管中管椎间孔镜下减压方法，并研究其治疗腰椎管狭窄症（LSS）的有效性和安全性。利用微内镜减压（MED）手术通道管的优势，我们采用水介质脊柱内镜进行经椎间孔椎管减压，即“管中管”技术。对35例行管中管技术治疗的LSS患者进行回顾性研究。所有患者术后随访12个月。术前及术后3、6、12个月收集视觉模拟量表（VAS）、日本矫形外科学会（JOA）评分和奥斯威斯利功能障碍指数（ODI）。采用简短健康调查（SF-36）评分评估患者术前及术后3个月和12个月的总体健康相关生活质量（HRQoL）。采用改良Macnab标准评估术后3个月和12个月的临床疗效。临床疗效满意，所有评分系统均有改善。VAS、JOA和ODI评分分别从术前的6.46±1.85、12.03±4.96和42.17±12.22改善至术后12个月的2.20±1.14、21.40±5.86和13.14±7.52（P＜0.001）。在3个月和12个月的随访中，Macnab优良率分别达到65.7%和77.1%。未发生严重并发症。管中管技术治疗LSS患者临床疗效良好，安全可靠、有效。然而，需要更多病例和多中心研究设计来进一步发展该技术。证据等级：IV级。
