Lewandrowski Kai-Uwe, Yeung Anthony
Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA.
Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Neurospine. 2020 Jul;17(Suppl 1):S34-S43. doi: 10.14245/ns.2040160.080. Epub 2020 Jul 31.
This study aimed to showcase the authors' preferred technique of a hybrid of modern "inside-out" and "outside-in" endoscopic decompression. A case series of 411 patients consisting of 192 females (46.7%) and 219 males (53.3%) with an average age of 54.84 ± 16.32 years and an average of 43.2 ± 26.53 months are presented. Patients underwent surgery for low-grade spondylolisthesis (13 of 411, 3.2%), herniated disc (135 of 411, 32.8%), foraminal spinal stenosis (101 of 411, 24.6%), or a combination of the latter 2 conditions (162 of 411, 39.4%). The preoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) for leg pain were 49.8 ± 17.65 and 7.9 ± 1.55, respectively. Postoperative ODI and VAS leg were 12.2 ± 9.34 and 2.41 ± 5 1.55 at final follow-up (p < 0.0001). MacNab outcomes were excellent in 134 (32.6%), good in 228 (55.5%), fair in 40 (9.7%), and poor in 9 patients (2.2%), respectively. There was end-stage degenerative vacuum disc disease in 304 of the 411 patients (74%) of which had 37.5% had excellent and 50% good MacNab outcomes. Patients without vacuum discs had excellent and good 18.7% and 71.0% of the time. Direct visualization of pain generators in the epidural- and intradiscal space is the authors' preferred transforaminal decompression technique and is supported by their reliable clinical outcomes.
本研究旨在展示作者所青睐的现代“由内而外”与“由外而内”内镜减压相结合的技术。呈现了一个包含411例患者的病例系列，其中女性192例（46.7%），男性219例（53.3%），平均年龄为54.84±16.32岁，平均病程为43.2±26.53个月。患者接受手术治疗的疾病包括低度腰椎滑脱（411例中的13例，3.2%）、椎间盘突出（411例中的135例，32.8%）、椎间孔狭窄（411例中的101例，24.6%），或后两种情况的组合（411例中的162例，39.4%）。术前的Oswestry功能障碍指数（ODI）和腿痛视觉模拟量表（VAS）分别为49.8±17.65和7.9±1.55。末次随访时，术后ODI和腿痛VAS分别为12.2±9.34和2.41±1.55（p<0.0001）。MacNab评估结果分别为：优134例（32.6%）、良228例（55.5%）、可40例（9.7%）、差9例（2.2%）。411例患者中有304例（74%）存在终末期退行性真空椎间盘病，其中37.5%的患者MacNab评估结果为优，50%为良。无真空椎间盘的患者MacNab评估结果为优和良的比例分别为18.7%和71.0%。作者所青睐的经椎间孔减压技术是直接观察硬膜外和椎间盘内的疼痛源，且其可靠的临床结果也支持了这一技术。
