Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.
Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China.
BMC Musculoskelet Disord. 2020 Feb 3;21(1):68. doi: 10.1186/s12891-020-3076-0.
The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis.
In this prospective study, 87 patients from Shanxi Province People's Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6 months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined.
The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P < 0.01). A significant difference was observed between the 71-81 year age group and the other age groups (P < 0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.
Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71 years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.
本研究旨在评估腰椎管狭窄症患者行内镜下经椎间孔减压术的临床疗效及其与术前影像学参数的相关性。
本前瞻性研究纳入 2014 年 6 月至 2016 年 1 月山西省人民医院符合腰椎管狭窄症标准的 87 例患者，均行经皮内镜下腰椎间孔减压术。术后 3 个月、6 个月时采用 VAS、ODI 及间歇性跛行评估临床症状，采用 MacNab 评分评估总体临床疗效。MRI 检测黄韧带厚度及硬脊膜囊面积，CT 检测骨性椎管面积、真实椎管面积、神经根根管骨性面积、神经根根管真实面积、关节间隙、椎管矢状径，计算椎管软组织侵占率及神经根根管侵占率，分析影像学参数与年龄、性别及临床疗效的相关性。
MacNab 评分优 47%，良 34%，可 8%，差 11%。术后 VAS、ODI、间歇性跛行评分较术前显著改善（P＜0.01）。71～81 岁年龄组与其他年龄组比较差异有统计学意义（P＜0.05）。临床疗效与椎管矢状径、关节间隙、椎管软组织侵占率、神经根根管侵占率呈正相关。
内镜下经椎间孔减压术治疗腰椎管狭窄症可获得良好的临床效果，71 岁以上患者疗效较差。临床疗效与椎管矢状径、关节间隙、椎管软组织侵占率、神经根根管侵占率呈正相关。
