Wu Junlong, Ao Shengxiang, Liu Huan, Wang Wenkai, Zheng Wenjie, Li Changqing, Zhang Chao, Zhou Yue
Department of Orthopaedics, Xinqiao Hospital; Army Medical University, Chongqing, China.
Department of Orthopaedics, the 941 Hospital of Chinese People Liberation Army, Xining, China.
Ann Transl Med. 2020 Oct;8(19):1215. doi: 10.21037/atm-20-1877.
Percutaneous transforaminal endoscopic lumbar decompression (PTELD) is an emerging surgical alternative for treating lumbar spinal stenosis (LSS). However, the foraminoplasty procedure often requires repeated fluoroscopy, and endoscopy just offers a local view. No studies have focused on decreasing radiation exposure with electromagnetic navigation assistance. This study introduces a novel electromagnetic-based navigation (EMN) endoscopic system for PTELD in patients with LSS and compares the results in navigation and fluoroscopy groups.
Eighty-eight patients with LSS were randomized into either a navigation (44 patients) or fluoroscopy group. Duration of surgery, cannula placement time, radiation dose, blood loss, intraoperative pain assessment, and postoperative hospitalization stay were evaluated. The clinical outcomes were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), 6-minute walk test, and modified Macnab criteria.
Eighty-five patients were followed-up for at least 12 months. The duration of surgery and cannula placement time were significantly more efficient in the navigation group (P=0.03 and P<0.001). Intraoperative pain assessment showed significantly less pain in the navigation group (P=0.038). The radiation dose was significantly higher in the fluoroscopy group than the navigation group (P<0.001). The VAS scores for back (P<0.001) and leg (P<0.001) pain improved significantly in both groups after surgery, as did the ODI (P<0.001) scores. Improvements in walking ability and Macnab criteria assessments at the 12-month follow-up, assessed subjective by patient assessments did not differ between the two groups.
The EMN system used in PTELD for patients with LSS compared to fluoroscopy enhances efficiency for foraminoplasty, reduces intraoperative pain and levels of radiation exposure. It results in outcomes comparable with results using fluoroscopy.
经皮椎间孔镜下腰椎减压术（PTELD）是治疗腰椎管狭窄症（LSS）的一种新兴手术方式。然而，椎间孔成形术通常需要反复进行荧光透视，且内镜仅提供局部视野。尚无研究关注在电磁导航辅助下减少辐射暴露。本研究引入一种用于LSS患者PTELD的新型基于电磁的导航（EMN）内镜系统，并比较导航组和荧光透视组的结果。
88例LSS患者被随机分为导航组（44例患者）和荧光透视组。评估手术时间、套管置入时间、辐射剂量、失血量、术中疼痛评估及术后住院时间。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、6分钟步行试验和改良Macnab标准评估临床结果。
85例患者随访至少12个月。导航组的手术时间和套管置入时间明显更高效（P = 0.03和P < 0.001）。术中疼痛评估显示导航组疼痛明显减轻（P = 0.038）。荧光透视组的辐射剂量明显高于导航组（P < 0.001）。两组术后背部（P < 0.001）和腿部（P < 0.001）疼痛的VAS评分以及ODI评分（P < 0.001）均显著改善。在12个月随访时，通过患者主观评估的步行能力和Macnab标准评估的改善在两组之间无差异。
与荧光透视相比，用于LSS患者PTELD的EMN系统提高了椎间孔成形术的效率，减轻了术中疼痛并降低了辐射暴露水平。其结果与使用荧光透视的结果相当。
