Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA.
Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA.
World Neurosurg. 2022 Aug;164:33-40. doi: 10.1016/j.wneu.2022.04.072. Epub 2022 Apr 25.
Surgical techniques to treat tumors of the spine often require extensive tissue dissection and bony removal, predisposing patients to elevated risk for perioperative morbidity and mortality. When indicated, minimally invasive surgical techniques may be preferred as they result in less collateral damage and quicker recovery times. Full endoscopic spine surgery (FES) represents an ultra-minimally invasive approach that further minimizes tissue damage. The advantages to the application of FES to treat spinal tumors remain unclear.
Electronic databases were systematically searched for published literature on the application of FES in spinal oncology to assess its utility, safety, and outcomes via Nurick, McCormick, and Frankel grades, visual analog scale, complication rate, duration of surgery, estimated blood loss, length of stay, and mean follow-up.
Fifteen articles describing 72 patients met inclusion criteria. The most common approach was the interlaminar approach (40.98%). The most common spinal level was lumbar (38.89%). The most common goal of surgery was gross total resection (82.11%). The average Nurick grade decreased from 2.96 to 0.67. All patients showed an improvement from Frankel grade C or D to grade E except for one. The average visual analog scale score decreased from 9.3 to 1.3. The complication rate was 6.56%. The average length of stay was 55.2 hours. The average estimated blood loss was 49 mL. The average duration of surgery was 121.26 minutes. The mean follow-up was 10.58 months.
The utility of FES in spinal oncology is not well understood. Literature results of this technique show promise. Further study is needed to draw definitive conclusions on FES efficacy and safety in spinal oncology.
治疗脊柱肿瘤的手术技术通常需要广泛的组织解剖和骨切除，使患者面临围手术期发病率和死亡率升高的风险。在适当的情况下，微创外科技术可能是首选，因为它们造成的附带损伤较小，恢复时间较快。全内镜脊柱手术 (FES) 代表了一种超微创手术方法，进一步减少了组织损伤。将 FES 应用于治疗脊柱肿瘤的优势尚不清楚。
系统地检索了电子数据库中关于 FES 在脊柱肿瘤学中的应用的文献，通过 Nurick、McCormick 和 Frankel 分级、视觉模拟评分、并发症发生率、手术持续时间、估计失血量、住院时间和平均随访时间来评估其效用、安全性和结果。
有 15 篇描述了 72 例患者的文章符合纳入标准。最常见的入路是经椎间孔入路（40.98%）。最常见的脊柱节段是腰椎（38.89%）。最常见的手术目标是大体全切除（82.11%）。平均 Nurick 分级从 2.96 降至 0.67。除 1 例外，所有患者的 Frankel 分级从 C 或 D 级均改善至 E 级。平均视觉模拟评分从 9.3 降至 1.3。并发症发生率为 6.56%。平均住院时间为 55.2 小时。平均估计失血量为 49ml。平均手术时间为 121.26 分钟。平均随访时间为 10.58 个月。
FES 在脊柱肿瘤学中的应用尚不清楚。该技术的文献结果显示出一定的前景。需要进一步的研究来得出关于 FES 在脊柱肿瘤学中的疗效和安全性的明确结论。
