Yang Fei, Chen Rigao, Gu Dangwei, Ye Qingqing, Liu Wei, Qi Jianhua, Xu Kai, Fan Xiaohong
Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China.
J Pain Res. 2020 Jun 11;13:1377-1384. doi: 10.2147/JPR.S254275. eCollection 2020.
Although lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients.
A retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria.
There are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05).
Both full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.
尽管腰椎管狭窄症（LSS）是老年人中最常见的脊柱疾病，但对于合适的手术治疗策略仍存在困惑。本研究的目的是比较全内镜和显微镜下单侧椎板切开双侧减压术（ULBD）治疗老年LSS患者的安全性和有效性。
对61例连续接受全内镜（FE组）或显微镜下（Micro组）单侧椎板切开双侧减压术的老年LSS患者进行回顾性分析。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和改良MacNab标准在术前、术后2周、3个月、6个月和12个月评估临床数据。
两组之间的VAS（背部和腿部）和ODI无显著差异。然而，FE组在术后2周时的背部疼痛VAS较Micro组有显著改善。FE组和Micro组的优良率分别为87.88%和85.71%（P>0.05）。FE组的住院时间和早期活动时间短于Micro组，但手术时间更长（P<0.05）。FE组（18.18%）和Micro组（17.86%）的并发症均较轻（P>0.05）。
全内镜和显微镜下减压术在治疗老年腰椎管狭窄症方面均取得了良好的临床效果，且并发症较轻。全内镜减压术具有切口小、恢复快的优点，可作为治疗腰椎管狭窄症的一种选择，尤其是合并多种疾病的老年人。
