Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China.
BMC Musculoskelet Disord. 2020 Oct 31;21(1):714. doi: 10.1186/s12891-020-03722-3.
At present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS?
This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.
All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 min. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P = 0.00), 2.47 (P = 0.71), and 19.40% (P = 0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28 ± 13.08 mm vs.104.91 ± 12.40 mm, P = 0.00).
Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.
目前，经皮内镜下经椎间孔减压术治疗中央型腰椎管狭窄症（CLSS）的报道较少。双侧经椎间孔入路内镜减压是否足以治疗退行性 CLSS？
本回顾性研究纳入了 47 例接受双侧经椎间孔内镜减压的 CLSS 患者。评估了 ODI、腰背和下肢 VAS、Macnab 标准等临床结果。还研究了手术结果，包括手术时间、术后住院时间、复发和手术并发症。影像学评估了腰椎稳定性，并比较了术前和术后腰椎硬膜囊的尺寸。
所有 47 例患者均获得随访，平均随访时间为 24.5 个月。平均手术时间为 116 分钟。下肢和腰背疼痛的平均 VAS 以及平均 ODI 从基线时的 7.81、2.53 和 77.03%分别改善至最终的 1.94（P=0.00）、2.47（P=0.71）和 19.40%（P=0.00）。根据 Macnab 标准，97.9%的患者获得了优秀和良好的结果。有 2 例硬脊膜撕裂和 3 例短暂性术后感觉异常。末次随访时，硬脊膜囊的横截面积明显增大（74.28±13.08mm 比 104.91±12.40mm，P=0.00）。
除了硬脊膜背侧的主要致病因素外，双侧经椎间孔入路经皮内镜减压术对 CLSS 是足够的。它是一种可行、安全且具有临床疗效的微创方法。
