Li Xingchen, Huang Honghan, Zheng Zhong, Liu Yunxuan, Wei Guicai, Chen Xiaoxin, Xu Yusheng
Department of Orthopedics Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou China.
Front Surg. 2022 May 6;9:897182. doi: 10.3389/fsurg.2022.897182. eCollection 2022.
To explore the clinical efficacy, characteristics and safety of endoscopic-assisted resection of single-segment posterior longitudinal ligament ossification in the treatment of thoracic spinal stenosis (TSS).
Fifteen TSS patients, including 6 males and 9 females aged 43-70 years treated with endoscopic-assisted resection of single-segment posterior longitudinal ligament ossification through the transfacet joint approach by our team from November 2016 to June 2020 were retrospectively analyzed. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, ODI and JOA score (full score, 11 points) were recorded before the operation, after the operation and at the last follow-up to evaluate the clinical efficacy and calculate the improvement rate.
The ventral side of the spinal cord was decompressed in all patients, providing improvements in neurological symptoms and significant pain relief. The mean follow-up time was 20.27 ± 3.87 months. Mean operation time, intraoperative blood loss, and hospitalization time were found to be 84.80 ± 13.23 min, 36.33 ± 7.41 mL, 5.13 ± 1.02 days; respectively.The JOA score at the last follow-up was 8.6 ± 1.25, which was significantly better than the preoperative (5.53 ± 1.20) and postoperative (6.87 ± 1.31) scores ( < 0.05). The mean JOA score improvement rate was 56.5 ± 18.00%. The JOA score improvement rate classification at the last follow-up was excellent in 3 cases, good in 8 cases, effective in 3 cases, and no change in 1 case; for an effective rate of 93.33%. The VAS score significantly decreased from 6.67 ± 1.01 preoperatively to 3.47 ± 0.88 postoperatively and 1.73 ± 0.67 at the last follow-up ( < 0.05). The ODI significantly decreased from 72.07 ± 6.08 preoperatively to 45.93 ± 5.01 postoperatively and 12.53 ± 2.33 at the last follow-up ( < 0.05). Dural rupture occurred in 2 patients during the operation; 1 patient experienced neck discomfort during the operation, which was considered to be caused by high fluid pressure and was relieved by massage and by lowering the height of the irrigation fluid. No cases of cerebrospinal fluid leakage, wound infection or other complications occurred.
Endoscopic-assisted resection of posterior longitudinal ligament ossification through the facet joint approach is a safe and effective method for the treatment of TSS.
探讨经内镜辅助下切除单节段后纵韧带骨化治疗胸椎管狭窄症（TSS）的临床疗效、特点及安全性。
回顾性分析2016年11月至2020年6月期间，我团队采用经关节突入路经内镜辅助下切除单节段后纵韧带骨化治疗的15例TSS患者，其中男性6例，女性9例，年龄43 - 70岁。记录手术时间、术中出血量及术后并发症。记录术前、术后及末次随访时的视觉模拟评分（VAS）、日本骨科学会（JOA）评分（满分11分）和Oswestry功能障碍指数（ODI），以评估临床疗效并计算改善率。
所有患者脊髓腹侧均获减压，神经症状改善，疼痛明显缓解。平均随访时间为20.27±3.87个月。平均手术时间、术中出血量及住院时间分别为84.80±13.23分钟、36.33±7.41毫升、5.13±1.02天。末次随访时JOA评分为8.6±1.25，显著优于术前（5.53±1.20）及术后（6.87±1.31）评分（P<0.05）。JOA评分平均改善率为56.5±18.00%。末次随访时JOA评分改善率分级：优3例，良8例，有效3例，无效1例；有效率为93.33%。VAS评分术前为6.67±1.01，术后降至3.47±0.88，末次随访时为1.73±0.67（P<0.05）。ODI术前为72.07±6.08，术后降至45.93±5.01，末次随访时为12.53±2.33（P<0.05）。术中2例患者发生硬膜破裂；1例患者术中出现颈部不适，考虑为冲洗液压力过高所致，经按摩及降低冲洗液高度后缓解。未发生脑脊液漏、伤口感染或其他并发症。
经关节突入路经内镜辅助下切除后纵韧带骨化是治疗TSS的一种安全有效的方法。
