Department of Neurosurgery, Nanoori Hospital Gangnam-gu, Seoul, Republic of Korea.
J Neurol Surg A Cent Eur Neurosurg. 2022 Mar;83(2):135-142. doi: 10.1055/s-0041-1725955. Epub 2021 Jul 8.
The aim of this retrospective case study was to analyze the outcomes of minimal nerve root retraction in patients with impending neurologic deficit in degenerative lumbar spine disease using the full-endoscopic spine surgery.
Thirty-seven consecutive patients with impending neurologic deficit underwent endoscopic spine surgery through either the transforaminal or the interlaminar approach. Their clinical outcomes were evaluated with visual analog scale (VAS) leg pain score, Oswestry Disability Index (ODI), and MacNab's criteria. The outcome of motor deficitis was evaluated with the Medical Research Council (MRC) grade. Completeness of decompression was documented with a postoperative magnetic resonance imaging (MRI) and computed tomography (CT) scan.
A total of 40 lumbar levels of 37 patients were operated, VAS score of the leg improved from 7.7 ± 1 to 1.9 ± 0.6 ( < 0.0001). ODI score improved from 74.7 ± 6.5 to 25.4 ± 3.49 ( < 0.0001). Motor weakness improved significantly immediately after surgery. The mean MRC grade increased to 1.97, 3.65, 4.41, and 4.76 preoperatively, at 1 week, at 3 months, and at the final follow-up, respectively, and all the patients with foot drop and cauda equina syndrome symptom recovered completely. One patient with great toe drop recovered partially to MRC grade 3. Mean follow-up of the study was 13.3 ± 6.1 months. According to MacNab's criteria, 30 patients (80.1%) had good and 7 patients (18.9%) had excellent results. Three patients required revision surgery.
Minimal nerve root retraction during full-endoscopic spine surgery is safe and effective for treatment of the impending neurologic deficit. We could achieve a thorough decompression of the affected nerve root with acceptable clinical outcome and minimal postoperative morbidity.
本回顾性病例研究旨在分析使用全内镜脊柱手术治疗退行性腰椎疾病伴即将出现神经功能缺损患者神经根最小牵开的效果。
37 例即将出现神经功能缺损的患者接受了经椎间孔或经椎板间入路的内镜脊柱手术。通过视觉模拟评分（VAS）腿部疼痛评分、Oswestry 残疾指数（ODI）和 MacNab 标准评估他们的临床结果。运动功能障碍的结果通过医疗研究委员会（MRC）分级进行评估。术后磁共振成像（MRI）和计算机断层扫描（CT）记录减压的完整性。
37 例患者共 40 个腰椎节段接受了手术，腿部 VAS 评分从 7.7±1 改善至 1.9±0.6（ < 0.0001）。ODI 评分从 74.7±6.5 改善至 25.4±3.49（ < 0.0001）。术后运动无力明显改善。术前 MRC 评分为 1.97、3.65、4.41 和 4.76，术后 1 周、3 个月和最终随访时分别为 3.65、4.41 和 4.76，所有足下垂和马尾综合征症状的患者均完全恢复。1 例大脚趾下垂患者部分恢复至 MRC 3 级。研究的平均随访时间为 13.3±6.1 个月。根据 MacNab 标准，30 例（80.1%）患者结果良好，7 例（18.9%）患者结果优秀。3 例患者需要再次手术。
全内镜脊柱手术中神经根最小牵开对于治疗即将出现的神经功能缺损是安全有效的。我们可以在获得可接受的临床效果和最小术后发病率的情况下，对受累神经根进行彻底减压。
