在单节段单侧腰椎管狭窄的显微内镜减压术中，减压及部分椎间盘切除术是否比单纯减压更具优势？
Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis?
作者信息
Burkhardt Benedikt W, Oertel Joachim M
机构信息
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
出版信息
Int J Spine Surg. 2021 Feb;15(1):94-104. doi: 10.14444/8013. Epub 2021 Feb 12.
BACKGROUND
Endoscopic techniques are well accepted as surgical technique for decompression of lumbar lateral recess stenosis (LRS). It is uncertain if there is a difference in clinical outcome for decompression alone (DA) or decompression with partial discectomy (DPD) for the treatment of LRS.
METHODS
All files of patients who underwent an endoscopic procedure for lumbar LRS were identified from a prospectively collected database. Preoperative magnetic resonance imaging and endoscopic video were analyzed with special focus on the technique of nerve root decompression. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the numeric rating scale (NRS) for leg and back pain, the Oswestry disability index (ODI), and the modified MacNab criteria to assess functional outcome and clinical success.
RESULTS
Sixty-six patients were identified of which 57 attended for evaluation (86.4%). DA was performed in 15 (26.3%) patients and DPD in 42 patients (73.7%). The mean follow-up was 45.0 months (range: 16-82 months). Fifty-two patients reported to be free of leg pain (91.1%), 42 patients had no noticeable back pain (73.7%), 49 patients had full muscle strength (85.9%), and 48 patients had no sensory disturbance (84.2%). The mean NRS for leg pain was 1, the mean NRS for back pain was 2, mean ODI was 16% (range: 0%-60%). Clinical success was noted in 49 patients (85.9%) and it was significantly higher for patients following DPD ( = .024). The overall repeat procedure rate was 12% with reoperation rate at the index segment in 10.5% of cases. There were no significant differences with respect to leg and back pain, ODI, and reoperation between both groups.
CONCLUSION
Microendoscopic DPD of LRS achieves a 92% clinical success rate which is significantly higher compared to 67% clinical success achieved by DA. There was no significant difference for the rate of reoperation, leg and back pain, and ODI.
LEVEL OF EVIDENCE
背景
内镜技术作为腰椎侧隐窝狭窄（LRS）减压的手术技术已被广泛接受。对于单纯减压（DA）或减压联合部分椎间盘切除术（DPD）治疗LRS的临床疗效是否存在差异尚不确定。
方法
从一个前瞻性收集的数据库中识别出所有接受过腰椎LRS内镜手术的患者档案。对术前磁共振成像和内镜视频进行分析，特别关注神经根减压技术。通过个人检查、标准化问卷评估临床疗效，问卷包括腿部和背部疼痛的数字评分量表（NRS）、Oswestry功能障碍指数（ODI）以及用于评估功能结局和临床成功率的改良MacNab标准。
结果
共识别出66例患者，其中57例前来接受评估（86.4%）。15例（26.3%）患者接受了DA，42例患者（73.7%）接受了DPD。平均随访时间为45.0个月（范围：16 - 82个月）。52例患者报告无腿部疼痛（91.1%），42例患者无明显背部疼痛（73.7%），49例患者肌肉力量完全正常（85.9%），48例患者无感觉障碍（84.2%）。腿部疼痛的平均NRS评分为1，背部疼痛的平均NRS评分为2，平均ODI为16%（范围：0% - 60%）。49例患者（85.9%）临床治疗成功，DPD术后患者的成功率显著更高（P = 0.024）。总体再次手术率为12%，索引节段的再次手术率为10.5%。两组在腿部和背部疼痛、ODI及再次手术方面无显著差异。
结论
LRS的显微内镜DPD临床成功率达92%，显著高于DA的67%临床成功率。再次手术率、腿部和背部疼痛以及ODI方面无显著差异。
证据等级
4级。
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