First Affiliated Hospital of Jinan University, Guangzhou, China.
Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical, Beijing, China.
Ann Palliat Med. 2021 Oct;10(10):10130-10146. doi: 10.21037/apm-21-198. Epub 2021 Sep 15.
To determine the clinical and radiological outcomes of full-endoscopic (FE) versus microscopic (MI) lumbar decompression laminectomy in the treatment of lumbar spinal stenosis (LSS), we performed a meta-analysis to explore the best choice for patients with LSS requiring surgical relief.
Literature searches of the PubMed, the Cochrane Library, Embase, Medline, Embase, and Web of Science databases were performed. The searches covered all indexed studies published between 2008 and 2020, using keywords identifying the patient group (lumbar spine stenosis) and the interventions (full-endoscopic lumbar decompression laminectomy and microscopic lumbar decompression laminectomy). A total of 1,727 patients were included in 10 studies. The primary outcomes of the analysis were visual analogue scale (VAS) scores for leg and back pain, and Oswestry Disability Index (ODI) score.
The meta-analysis of the VAS score for low back pain showed that in the first 24 hours postoperatively, participants who underwent FE had better pain control than those who underwent MI [FE: mean difference (MD) =-0.78, 95% confidence interval (CI): -1.11, -0.45; MI: MD =-1.53, 95% CI: -1.94, -1.12]. In all subgroup analyses, the VAS score for back pain was lower in the FE group than in the MI group (MD =-0.71, 95% CI: -0.96, -0.47). Regarding the VAS score for leg pain, the FE group had a significantly lower score than the MI group in the first 24 hours (Total: MD =-1.02, 95% CI: -1.31, -0.73). The meta-analysis demonstrated that the FE group had a significantly lower ODI score than the MI group (MD =-1.03, 9% CI: -1.54, -0.51). At 6 months, the MI group had a significantly lower score than the FE group (MD =1.09, 95% CI: 0.53, 1.64), but at 12 months, the FE group had a significantly lower score than the MI group (MD =-2.40, 95% CI: -3.12, -1.67).
Compared to MI decompression, the FE decompression method resulted in better pain control in the early postoperative period, both in the lower back and legs, as well as shorter operative and shorter hospitalization times.
为了确定全内镜（FE）与显微镜（MI）腰椎减压椎板切除术治疗腰椎管狭窄症（LSS）的临床和影像学结果，我们进行了荟萃分析，以探讨需要手术缓解的 LSS 患者的最佳选择。
对 PubMed、Cochrane 图书馆、Embase、Medline、Embase 和 Web of Science 数据库进行文献检索。搜索涵盖了 2008 年至 2020 年期间发表的所有索引研究，使用关键词确定患者群体（腰椎管狭窄症）和干预措施（全内镜腰椎减压椎板切除术和显微镜腰椎减压椎板切除术）。共有 10 项研究纳入了 1727 名患者。分析的主要结果是腿部和背部疼痛的视觉模拟量表（VAS）评分以及 Oswestry 残疾指数（ODI）评分。
术后 24 小时内，接受 FE 治疗的患者的腰痛 VAS 评分明显优于接受 MI 治疗的患者[FE：平均差异（MD）=-0.78，95%置信区间（CI）：-1.11，-0.45；MI：MD=-1.53，95% CI：-1.94，-1.12]。在所有亚组分析中，FE 组的背痛 VAS 评分均低于 MI 组（MD=-0.71，95% CI：-0.96，-0.47）。对于腿部疼痛的 VAS 评分，FE 组在术后 24 小时内的评分明显低于 MI 组（总评分：MD=-1.02，95% CI：-1.31，-0.73）。荟萃分析表明，FE 组的 ODI 评分明显低于 MI 组（MD=-1.03，9% CI：-1.54，-0.51）。6 个月时，MI 组的评分明显低于 FE 组（MD=1.09，95% CI：0.53，1.64），但 12 个月时，FE 组的评分明显低于 MI 组（MD=-2.40，95% CI：-3.12，-1.67）。
与 MI 减压相比，FE 减压方法在术后早期无论是背部还是腿部都能更好地控制疼痛，并且手术时间和住院时间更短。
