Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona, USA and Visiting Professor, Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil.
Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago, Chile and Visiting Professor, Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil.
World Neurosurg. 2021 Jan;145:631-642. doi: 10.1016/j.wneu.2020.03.076. Epub 2020 Mar 19.
The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined.
We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria.
Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months).
We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.
经皮内窥镜下腰椎间孔入路治疗腰椎管狭窄症的适应证和禁忌证尚未明确。
我们对以下类型的腰椎管狭窄症患者进行 Kaplan-Meier 耐用性生存分析：I 型，中央椎管；II 型，侧隐窝；III 型，椎间孔；IV 型，椎间孔外。304 例患者包括 140 例男性和 164 例女性，平均年龄 51.68±15.78 岁。平均随访时间为 45.3 年（18-90 年）。主要临床疗效评价指标为 Oswestry 功能障碍指数、视觉模拟评分和改良 Macnab 标准。
304 例研究患者中，I 型狭窄 70 例（23.0%），II 型狭窄 42 例（13.7%），III 型狭窄 151 例（49.7%），IV 型狭窄 41 例（13.5%）。114 例（37.5%）患者获得了优秀的结果，152 例（50.0%）为良好，33 例（10.9%）为可，5 例（1.6%）为差。经皮内窥镜下减压手术的临床治疗获益的 Kaplan-Meier 耐用性分析显示，在 Log-rank（Mantel-Cox）χ检验中，I 型（28 个月）、II 型（53 个月）、III 型（32 个月）和 IV 型（66 个月）的估计中位（50%分位数）生存时间存在统计学差异（P<0.0001）。
我们建议根据潜在的压迫性疾病和经皮内窥镜脊柱外科医生的技能水平对患者进行分层，以便在术前决定是否应考虑更困难的中央或复杂椎间孔狭窄病变的替代经皮内窥镜方法。
