Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China.
Minimally Invasive Spine Center, Changhua Christian Hospital, No.135, Nansiao St., Changhua city, Changhua county, Taiwan.
BMC Musculoskelet Disord. 2020 Aug 14;21(1):546. doi: 10.1186/s12891-020-03566-x.
BACKGROUND: One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). METHODS: This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. RESULTS: The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. CONCLUSION: The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.
背景：内镜治疗腰椎管狭窄症的一个优势是保留脊柱稳定性和相邻结构，并且相邻节段椎间盘退变减少。本研究旨在探讨经皮椎间孔内镜减压术（PTED）治疗腰椎管狭窄症（LSS）的临床疗效。
方法：这是一项回顾性研究。2012 年 9 月至 2017 年 6 月，45 例 LSS 患者接受了经皮椎间孔内镜减压术（PTED）治疗，术后 1 周、3 个月和 1 年进行随访。腰痛和腿痛采用视觉模拟评分法（VAS-back 和 VAS-leg）进行测量，而功能结果采用 Oswestry 功能障碍指数（ODI）进行评估。所有患者均为单节段腰椎管狭窄症。
结果：最常见的狭窄类型是侧隐窝狭窄（n=22；48.9%），其次是中央狭窄（n=13；28.9%）和椎间孔狭窄（n=10；22.2%）。比较术前和术后 VAS-back、VAS-leg 和 ODI 评分，VAS 和 ODI 评分均明显改善。平均腿痛 VAS 评分从 7.01±0.84 改善至 2.28±1.43（P<0.001）。平均 ODI 从 46.18±10.11 改善至 14.40±9.59（P<0.001）。我们还根据脊柱狭窄类型、狭窄程度、脊柱不稳和同一节段再次手术检查了 ODI 和 VAS 评分从基线开始的变化。术后 3 个月和 1 年，严重狭窄患者的腿痛 VAS 评分改善百分比明显较低。脊柱不稳和同一节段再次手术患者的 ODI 和腿痛 VAS 评分改善百分比明显较低。
结论：PTED 方法似乎为 LSS 的治疗提供了良好的结果。然而，对于有腰椎不稳或同一节段需要再次手术的 LSS 患者，该方法的效果可能较差。
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