显微镜下减压术与开放椎板切除术和后路固定治疗多节段腰椎管狭窄症的随机对照试验。
Microdecompression versus Open Laminectomy and Posterior Stabilization for Multilevel Lumbar Spine Stenosis: A Randomized Controlled Trial.
机构信息
Department of Orthopaedics, College of Medicine, Hawler Medical University, Erbil, Iraq.
Department of Neurosurgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
出版信息
Pain Res Manag. 2019 Nov 7;2019:7214129. doi: 10.1155/2019/7214129. eCollection 2019.
BACKGROUND
Lumbar spinal stenosis most often results from a gradual, degenerative ageing process. Open or wide decompressive laminectomy was formerly the standard treatment. However, in recent years, a growing tendency towards less invasive decompressive procedures has emerged. The purpose of this study was to compare the results of microdecompression with those of open wide laminectomy and posterior stabilization for patients with symptomatic multilevel lumbar spinal stenosis who failed to respond to conservative treatment.
METHODS
This randomized controlled study was conducted between January 2016 and October 2018. One hundred patients were involved in this study. All these patients suffered from radicular leg pain with MRI features of multilevel lumbar spinal stenosis and were treated by conservative treatment of medical treatment and physiotherapy without benefit for 6 months. Those patients were divided into two groups: Group A, 50 microdecompression, and Group B, 50 patients who were treated by open wide laminectomy and posterior stabilization. Both groups of patients were followed up with ODI (Oswestry disability index) and VAS (visual analogue score) for the back and leg pain for one year.
RESULTS
The results showed that both groups got significant improvement regarding the Oswestry disability index. Regarding back pain, there was a significant improvement in both groups with better results in group A due to minimal tissue injury as the advantage of the minimal invasive technique. In both groups, there was marked improvement of radicular leg pain postoperatively.
CONCLUSIONS
Both microdecompression and wide open laminectomy with posterior stabilization were effective in treatment of multilevel lumbar spinal stenosis with superior results of microdecompression regarding less back pain postoperatively with less blood loss and soft tissue dissection. Clinical trial number: NCT04087694.
背景
腰椎管狭窄症最常由逐渐的退行性老化过程引起。传统的标准治疗方法是开放性或广泛性减压椎板切除术。然而，近年来，微创手术的趋势逐渐兴起。本研究旨在比较微创减压术与开放性广泛椎板切除术和后路稳定术治疗对保守治疗无效的多节段腰椎管狭窄症患者的疗效。
方法
这是一项在 2016 年 1 月至 2018 年 10 月间进行的随机对照研究。共有 100 例患者参与了本研究。所有患者均存在神经根性腿痛，MRI 表现为多节段腰椎管狭窄，经保守治疗（包括药物治疗和物理治疗）6 个月无效。将这些患者分为两组：A 组 50 例，采用微创减压术治疗；B 组 50 例，采用开放性广泛椎板切除术和后路稳定术治疗。两组患者均采用 ODI（Oswestry 功能障碍指数）和 VAS（视觉模拟评分）对腰背腿痛进行为期 1 年的随访。
结果
结果显示，两组患者的 Oswestry 功能障碍指数均有显著改善。在腰背疼痛方面，两组患者均有显著改善，其中 A 组患者由于微创技术的优势导致组织损伤较小，因此效果更好。两组患者术后神经根性腿痛均有明显改善。
结论
微创减压术和开放性广泛椎板切除术加后路稳定术治疗多节段腰椎管狭窄症均有效，微创减压术术后腰背疼痛较轻，出血量少，软组织分离少，效果优于开放性广泛椎板切除术。临床试验注册号：NCT04087694。
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