J Neurosurg Spine. 2021 Nov 12;36(4):549-557. doi: 10.3171/2021.8.SPINE21890. Print 2022 Apr 1.
Lumbar stenosis treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis.
Following PRISMA guidelines, a systematic search was performed using the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid Embase, and PubMed databases from their dates of inception to December 14, 2020. All identified articles were then systematically screened against the following inclusion criteria: 1) studies comparing endoscopic (either uniportal or biportal) with minimally invasive approaches, 2) patient age ≥ 18 years, and 3) diagnosis of lumbar spinal stenosis. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata.
From a total of 470 studies, 14 underwent full-text assessment. Of these 14 studies, 13 comparative studies were included for quantitative analysis, totaling 1406 procedures satisfying all criteria for selection. Regarding postoperative back pain, 9 studies showed that endoscopic methods resulted in significantly lower pain scores compared with MIS (mean difference [MD] -1.0, 95% CI -1.6 to -0.4, p < 0.01). The length of stay data were reported by 7 studies, with endoscopic methods associated with a significantly shorter length of stay versus the MIS technique (MD -2.1 days, 95% CI -2.7 to -1.4, p < 0.01). There was no significant difference with respect to leg visual analog scale scores, Oswestry Disability Index scores, blood loss, surgical time, and complications, and there were not any significant quality or bias concerns.
Both endoscopic and MIS techniques are safe and effective methods for treating patients with symptomatic lumbar stenosis. Patients who undergo endoscopic surgery seem to report less postoperative low-back pain and significantly reduced hospital stay with a trend toward less perioperative blood loss. Future large prospective randomized trials are needed to confirm the findings in this study.
腰椎狭窄症的治疗随着微创外科（MIS）技术的引入而发展。内窥镜方法将应用于 MIS 的概念进一步推进，多项研究表明，内窥镜技术的结果与更传统的方法相似。本研究的目的是对比较内窥镜（单端口和双端口）和显微镜技术治疗腰椎狭窄症的疗效的研究进行更新的荟萃分析和系统评价。
根据 PRISMA 指南，使用 Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、Ovid Embase 和 PubMed 数据库从其成立日期到 2020 年 12 月 14 日进行系统检索。然后根据以下纳入标准对所有确定的文章进行系统筛选：1）比较内窥镜（单端口或双端口）与微创方法的研究，2）患者年龄≥18 岁，3）诊断为腰椎椎管狭窄症。使用质量评估标准和漏斗图评估偏倚。使用随机效应模型进行荟萃分析以综合元数据。
从总共 470 项研究中，有 14 项进行了全文评估。在这 14 项研究中，有 13 项比较研究被纳入定量分析，共有 1406 例符合所有选择标准的手术。关于术后腰痛，9 项研究表明，与 MIS 相比，内窥镜方法导致疼痛评分显著降低（平均差值[MD]-1.0，95%置信区间[CI]-1.6 至-0.4，p<0.01）。7 项研究报告了住院时间数据，与 MIS 技术相比，内窥镜方法的住院时间明显缩短（MD-2.1 天，95%CI-2.7 至-1.4，p<0.01）。在腿部视觉模拟评分、Oswestry 残疾指数评分、失血量、手术时间和并发症方面没有显著差异，也没有任何明显的质量或偏倚问题。
内窥镜和 MIS 技术都是治疗有症状的腰椎狭窄症患者的安全有效的方法。接受内窥镜手术的患者术后腰痛明显减轻，住院时间明显缩短，手术期间失血量有减少趋势。需要进行未来的大型前瞻性随机试验来证实本研究的结果。
