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腰椎微内窥镜减压治疗腰椎管狭窄症伴或不伴退行性腰椎滑脱的长期疗效:至少 10 年随访。

Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up.

机构信息

Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan; Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.

Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.

出版信息

World Neurosurg. 2021 Feb;146:e1219-e1225. doi: 10.1016/j.wneu.2020.11.131. Epub 2020 Nov 30.

DOI:10.1016/j.wneu.2020.11.131
PMID:33271376
Abstract

OBJECTIVE

To determine whether preoperative presence of degenerative lumbar spondylolisthesis (DS) worsens the minimum 10-year outcome of patients undergoing microendoscopic decompression (MED) for lumbar spinal stenosis (SS).

METHODS

Eighty patients undergoing MED were classified into 2 groups: DS group (34 SS with DS patients) and SS group (46 SS without DS patients). The degrees of improvement (DOIs) by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and intensities of improvement (IOIs) by Visual Analog Scale (VAS) at 120-159 (mean, 138.4) months after MED of the DS and SS groups were statistically compared. Patients with DS were classified into 2 groups based on the effectiveness by VAS or JOABPEQ: effective group (E group: IOI or DOI ≥20) and ineffective group (I group). All preoperative radiologic measurements were statistically compared between the E and I groups.

RESULTS

Significant decreases in low back pain, leg pain, and numbness, as measured by VAS, were noted at follow-up in the DS and SS groups. The effectiveness rates of pain-related disorders, lumbar spine dysfunction, and gait disturbance by JOABPEQ were almost equally high in the DS and SS groups. Statistical comparisons of the DOIs in all 5 functional scores and IOIs in low back pain, leg pain, and numbness showed no significant differences between the DS and SS groups. No significant differences were confirmed between the E and I groups concerning preoperative spondylolisthesis and instability.

CONCLUSIONS

Our study indicated that preoperative DS did not worsen the outcome of patients with SS undergoing MED.

摘要

目的

确定退行性腰椎滑脱(DS)术前存在是否会使接受腰椎管狭窄症(SS)微创减压(MED)的患者的最低 10 年预后恶化。

方法

将 80 例接受 MED 的患者分为 2 组:DS 组(34 例 SS 合并 DS 患者)和 SS 组(46 例 SS 不合并 DS 患者)。使用日本矫形协会腰痛评估问卷(JOABPEQ)评估的改善程度(DOI)和视觉模拟量表(VAS)的改善强度(IOI)在 MED 后 120-159 个月(平均 138.4 个月)时在 DS 和 SS 组之间进行统计学比较。根据 VAS 或 JOABPEQ 的有效性,将 DS 患者分为 2 组:有效组(E 组:IOI 或 DOI≥20)和无效组(I 组)。比较 E 组和 I 组之间所有术前放射学测量值。

结果

在随访时,DS 和 SS 组的 VAS 测量值均显示腰痛、腿痛和麻木明显减轻。JOABPEQ 评估的与疼痛相关的疾病、腰椎功能障碍和步态障碍的有效率在 DS 和 SS 组几乎相同。所有 5 个功能评分的 DOI 和腰痛、腿痛和麻木的 IOI 的统计学比较在 DS 和 SS 组之间无显著差异。E 组和 I 组在术前滑脱和不稳定方面无显著差异。

结论

我们的研究表明,术前 DS 不会使接受 MED 的 SS 患者的预后恶化。

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