Li Xin-Feng, Jin Lin-Yu, Lv Zhen-Dong, Su Xin-Jin, Wang Kun, Shen Hong-Xing, Song Xiao-Xing
Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200444, P.R. China.
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China.
Exp Ther Med. 2020 Feb;19(2):1417-1424. doi: 10.3892/etm.2019.8337. Epub 2019 Dec 17.
The efficacy of fusion combined with decompression for the treatment of spinal stenosis with degenerative lumbar spondylolisthesis (DLS) has been debated. Percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia is an ultra-minimally invasive procedure. The present study aimed to evaluate whether PTED is an effective alternative therapy for spinal stenosis associated with DLS in elderly patients. PTED was performed in elderly patients exhibiting lumbar stenosis and low-grade (Meyerding grades I and II) DLS; these patients also exhibited leg-dominant symptoms and had tolerable or absent mechanical back pain. Administration of general anesthesia may be considerably hazardous in patients when combined with comorbid conditions that result from aging. Therefore, the present procedure was performed under local anesthesia. No obvious radiographic lumbar intervertebral instability was identified prior to surgery. Pre- and post-operative visual analogue scale (VAS) score, Oswestry Disability Index (ODI) and walking distance data were collected. The clinical global outcomes following surgery were evaluated using modified MacNab criteria. A total of 18 elderly patients underwent surgery using PTED techniques. The mean follow-up time was 27.7 months (range, 24-33 months) and the mean estimated blood loss was 18.33 ml (range, 10-35 ml). The mean pre-operative ODI, VAS score of the back and VAS score of the leg were 68.2±6.5, 2.8±1.4 and 6.6±1.2, respectively. All average scores improved post-operatively to 31.7±5.2, 1.5±0.6 and 1.7±0.8, respectively, at the latest follow-up. A statistically significant improvement was observed for all scores at 1 month and that the scores remained relatively stable after that. According to modified MacNab criteria, the good-to-excellent rate was 83.3%. Only 1 patient required micro-decompression surgery due to poor rating. The present study indicated that PTED may be an effective alternative therapeutic option for elderly patients with low-grade DLS associated with spinal stenosis. However, PTED techniques continue to evolve and further follow-up studies are required to determine the long-term outcomes of this treatment technique.
融合术联合减压术治疗退行性腰椎滑脱症（DLS）合并腰椎管狭窄症的疗效一直存在争议。局部麻醉下的经皮椎间孔镜减压术（PTED）是一种超微创手术。本研究旨在评估PTED是否是老年DLS合并腰椎管狭窄症患者的一种有效替代疗法。对表现出腰椎管狭窄和低度（Meyerding分级I和II级）DLS的老年患者实施PTED；这些患者还表现出以腿部为主的症状，且机械性背痛可耐受或无背痛。老年患者若合并因衰老导致的共病，全身麻醉的风险可能相当大。因此，本手术在局部麻醉下进行。术前未发现明显的腰椎影像学不稳定。收集术前和术后视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及步行距离数据。采用改良MacNab标准评估术后临床总体疗效。共有18例老年患者采用PTED技术进行手术。平均随访时间为27.7个月（范围24 - 33个月），平均估计失血量为18.33 ml（范围10 - 35 ml）。术前平均ODI、背部VAS评分和腿部VAS评分分别为68.2±6.5、2.8±1.4和6.6±1.2。在最近一次随访时，所有平均评分术后分别改善至31.7±5.2、1.5±0.6和1.7±0.8。所有评分在术后1个月均有统计学意义的改善，之后评分保持相对稳定。根据改良MacNab标准，优良率为83.3%。仅1例患者因评分不佳需要进行显微减压手术。本研究表明，PTED可能是老年低度DLS合并腰椎管狭窄症患者的一种有效替代治疗选择。然而，PTED技术仍在不断发展，需要进一步的随访研究来确定该治疗技术的长期疗效。
