Yankang Liu, Leiming Zhang, Lewandrowski Kai-Uwe, Xiangyu Tang, Zexing Zhu, Jianbiao Xu, Lin Zhang, Heng Yuan, Xifeng Zhang
Shanxi Medical University, Taiyuan, China.
Department of Neurosurgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.
Int J Spine Surg. 2021 Feb;15(1):105-112. doi: 10.14444/8014. Epub 2021 Feb 12.
Typically, open surgery is advocated for cauda equina patients. The goal of this study was to compare the clinical efficacy of full endoscopic lumbar discectomy and laminectomy in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation.
Forty-three patients with CES either underwent endoscopic or laminectomy surgery from May 2015 to April 2016, and data were collected and retrospectively analyzed. The patients were divided into 2 groups according to the surgical methods: the endoscopy group (with 21 patients, 14 males and 7 females, and an average age of 42.67 with a standard deviation of 9.70 years) and the laminectomy group (with 22 patients, 16 males and 6 females, and an average age of 44.55 with a standard deviation of 9.36 years). The modified Japanese Orthopaedic Association (JOA) "leg-trunk-bladder" score was used to assess the efficacy of the respective surgical methods.
Analysis showed longer surgery time, more bleeding, and longer hospital stay in the laminectomy group than in the endoscopy group with statistical significance. The postoperative JOA scores improved in both groups when compared with those before the operation, and the differences were statistically significant. There were no significant differences in JOA scores between the 2 groups at preoperation and 6-month and 1-year follow-ups. There was 1 patient in each group whose CES symptoms worsened after endoscopy. However, immediate reoperation resulted in satisfactory outcomes.
CES clinical symptom resolution was equal with endoscopy and laminectomy both in short-term and midterm follow-up. However, endoscopic treatment was advantageous by reducing the amount of bleeding, duration of surgery, and hospitalization days when compared to laminectomy.
Feasibility study Endoscopic Decompression for Cauda Equina.
通常情况下，马尾神经损伤患者主张采用开放手术。本研究的目的是比较全内镜下腰椎间盘切除术与椎板切除术治疗腰椎间盘突出症所致马尾神经综合征（CES）的临床疗效。
2015年5月至2016年4月，43例CES患者接受了内镜手术或椎板切除术，并收集数据进行回顾性分析。根据手术方式将患者分为2组：内镜组（21例，男14例，女7例，平均年龄42.67岁，标准差9.70岁）和椎板切除组（22例，男16例，女6例，平均年龄44.55岁，标准差9.36岁）。采用改良日本骨科学会（JOA）“下肢-躯干-膀胱”评分评估各自手术方法的疗效。
分析显示，椎板切除组的手术时间更长、出血量更多、住院时间更长，与内镜组相比具有统计学意义。两组术后JOA评分均较术前有所改善，差异具有统计学意义。两组术前、术后6个月及1年随访时JOA评分差异无统计学意义。每组各有1例患者在内镜检查后CES症状加重。然而，立即再次手术取得了满意的效果。
在短期和中期随访中，内镜手术和椎板切除术在CES临床症状缓解方面相当。然而，与椎板切除术相比，内镜治疗在减少出血量、手术时间和住院天数方面具有优势。
3级。
马尾神经内镜减压可行性研究。
