Department of Neurosurgery, Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea; Orthopaedic Surgery, National University Health System, Jurong Health Campus, Singapore.
Neurol India. 2020 Sep-Oct;68(5):1157-1165. doi: 10.4103/0028-3886.299145.
A paucity of literature on the effect of spinal endoscopic surgery replacing a large percentage of open and microscopic minimally invasive surgery on outcomes in patients.
Evaluation of the effect of endoscopic practice expansion in degenerative spinal conditions and disc herniations on patients' outcome as we shifted from first-generation endoscopic discectomy to second-generation decompression and finally third generation of endoscopic spinal fusion practice.
Retrospective cohort study on surgical treatment of degenerative spinal conditions for 616 spinal cases. Basic demographics, preoperative, postoperative 1 week, 6 months, and final follow-up of patients' clinical outcomes in terms of pain score, Oswestry disability index, and MacNab's criteria for pain score were evaluated.
75%, 91%, and 97% of the surgeries with complications rate of 8.2%, 9%, and 3.4% were found in Generation 1, 2, and 3 of endoscopic surgery, respectively. Compared to preoperative scores, each generation VAS and ODI scores all statistically significantly improved. In the final follow-up, compared to preoperative state, the mean VAS improvement was 4.75 ± 1.7, 5.49 ± 1.66, and 5.37 ± 1.70, mean ODI improvement was 45.99 ± 11.8, 48.93 ± 11.2, and 48.43 ± 11.41, and MacNab's criteria showed a trend of upward improvement of 87.3%, 96.0%, and 98.7% cases, which showed good-to-excellent outcome, in Generation 1, 2, and 3, respectively.
Generation change of increasing percentage of endoscopic surgeries and expansion of endoscopic spinal indications over open surgeries in degenerative spinal conditions and disc herniations are possible as a surgeon gets more experience with endoscopic spine surgery producing a good clinical outcome.
目前关于脊柱内镜手术替代大部分开放性和显微镜下微创手术对患者疗效影响的文献较少。
评估我们从第一代内镜椎间盘切除术向第二代减压术，最终向第三代内镜脊柱融合术转变时，内镜技术在退行性脊柱疾病和椎间盘突出症中的应用扩展对患者疗效的影响。
对 616 例退行性脊柱病例的手术治疗进行回顾性队列研究。评估患者的基本人口统计学数据、术前、术后 1 周、6 个月和最终随访时的临床结果，包括疼痛评分、Oswestry 残疾指数和 MacNab 疼痛评分标准。
在第一代、第二代和第三代内镜手术中，并发症发生率分别为 8.2%、9%和 3.4%，手术成功率分别为 75%、91%和 97%。与术前评分相比，每一代 VAS 和 ODI 评分均有显著改善。在最终随访时，与术前相比，平均 VAS 改善分别为 4.75±1.7、5.49±1.66 和 5.37±1.70，平均 ODI 改善分别为 45.99±11.8、48.93±11.2 和 48.43±11.41，MacNab 标准显示出 87.3%、96.0%和 98.7%的病例有向上改善的趋势，分别为第一代、第二代和第三代的优良至极好疗效。
随着外科医生内镜脊柱手术经验的增加，退行性脊柱疾病和椎间盘突出症中内镜手术的比例不断增加，内镜脊柱手术适应证不断扩大，有可能替代开放性手术，产生良好的临床疗效。
