Department of orthopedic Surgery, 923nd Hospital of People's Liberation Army, Guangxi Province, China.
Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi Province, China.
Acta Orthop Traumatol Turc. 2021 Mar;55(2):166-170. doi: 10.5152/j.aott.2021.20076.
This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiological outcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability.
A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminal percutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study. The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disability index (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, and at the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery at the final follow-up.
An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33 patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and 23.11±9.97 at the final follow-up (p<0.05 for each evaluation point). The mean VAS score of the leg and lower back significantly decreased from 6.10±0.96 and 5.71±1.13 preoperatively to 1.69±0.96, 2.24±1.01 at postoperative 1 week, 1.69±0.84, 2.45±0.87 at 3 months, 1.71±0.81, 2.38±0.79 at 1 year, and 1.71±0.92, 2.48±0.67 at the final follow-up, respectively (p<0.05 for each evaluation term). Postoperative computed tomography or magnetic resonance imaging showed adequate decompression of the central or lateral recess and removal of combined herniated discs.
The results of our preliminary study have demonstrated that full endoscopic spine surgery is a safe and efficient technique for the therapy of neurogenic claudication and radiculopathy in elderly patients with lumbar spinal stenosis.
Level IV, Therapeutic Study.
本研究旨在探讨全内镜脊柱手术对无明显节段不稳的 70 岁以上老年腰椎管狭窄症患者的临床和影像学疗效。
回顾性分析 47 例（男 27 例，女 20 例；平均年龄=74.23±5.16 岁）经全内镜脊柱手术治疗的腰椎管狭窄症患者的临床资料。平均随访 26±2.97 个月。采用 Oswestry 功能障碍指数（ODI）和腿痛、腰痛视觉模拟评分（VAS）评估手术前后 1 周、3 个月和 1 年及末次随访时的临床疗效，末次随访时采用改良 MacNab 标准评估手术的临床疗效。
末次随访时改良 MacNab 标准评定优 9 例（19.1%），良 33 例（70.2%），可 3 例（6.4%），差 2 例（4.3%）。ODI 评分由术前的 71.29±5.69 分显著改善至术后 1 周的 32.05±10.71 分、3 个月的 30.27±9.89 分、1 年的 27.23±8.47 分、末次随访的 23.11±9.97 分（各评估点均 P<0.05）。腿痛、腰痛 VAS 评分由术前的 6.10±0.96、5.71±1.13 分显著降低至术后 1 周的 1.69±0.96、2.24±1.01 分、3 个月的 1.69±0.84、2.45±0.87 分、1 年的 1.71±0.81、2.38±0.79 分、末次随访的 1.71±0.92、2.48±0.67 分（各评估项均 P<0.05）。术后 CT 或 MRI 显示中央或侧隐窝减压充分，合并椎间盘突出完全切除。
初步研究结果表明，全内镜脊柱手术治疗老年腰椎管狭窄症患者的神经源性间歇性跛行和根性症状安全有效。
IV 级，治疗性研究。
