Yu K Y, Sun Q, Zhang J G, Bian C M, Si Chunming
Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Orthopedics, Xinjiang Production and Construction Corps Hospital, Urumqi 830092, China.
Zhonghua Yi Xue Za Zhi. 2022 Nov 8;102(41):3288-3294. doi: 10.3760/cma.j.cn112137-20220709-01521.
To evaluate the preliminary clinical outcomes of biportal endoscopic lumbar interbody fusion (BE-LIF), decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability. The data of 9 patients with single-level lumbar spinal stenosis who underwent BE-LIF, decompression and pedicle screw insertion assisted with biportal endoscopy in Xinjiang Production and Construction Corps Hospital from March 1st 2022 to April 30th 2022 were analyzed retrospectively. The visual analogue scales (VAS) for pain in back and legs, and the Oswestry disability index (ODI) of all the patients were collected before operation, on the third day after operation and at the last follow-up. Moreover, the operation time, intra-operation blood loss, radiation shots for pedicle screw insertion, post-operation drainage and ambulation time were recorded. The screw position was checked with CT after the operation. All the patients were female with a mean age of (70.3±8.4) years (ranged 56-84 years); the patients were followed-up for 12-16 weeks. All 9 patients had good clinical results. The VAS scores for back pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(2.9±0.6), (1.8±0.4) vs (6.4±1.1) points, both <0.05]. The VAS scores for leg pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(1.9±0.3), (1.4±0.5) vs (7.3±1.6) points, <0.05]. The ODI scores at last follow-up was significantly lower than that before the operation ((24.0%±6.5% vs 55.7%±12.8%, <0.05). The intra-operative blood loss was (177±103) ml, the drainage amounts post-operation was (122±56) ml, the operation time was (207.8±32.7)min, the ambulation time was (2.3±0.5) days. The total radiation shots for pedicle screw insertion were 20-42 times, the average radiation shots per screw was (6.9±1.5) times. No severe complications or adverse events occurred. No nerve root injury or dural tear occurred in the operation, and no revision surgery needed. The pedicle screw insertion assisted with biportal endoscopic technique can decrease the radiation exposure with good feasibility and safety during the BE-LIF. The BE-LIF combined with the pedicle screw insertion assisted with biportal endoscopy is an effective and safe surgery for lumbar spinal stenosis with good early results.
评估双门内镜下腰椎椎间融合术(BE-LIF)、减压及内镜辅助下椎弓根螺钉置入术治疗腰椎管狭窄症合并腰椎滑脱或不稳的初步临床疗效。回顾性分析2022年3月1日至2022年4月30日在新疆生产建设兵团医院接受BE-LIF、减压及双门内镜辅助下椎弓根螺钉置入术的9例单节段腰椎管狭窄症患者的数据。收集所有患者术前、术后第3天及末次随访时的腰腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。此外,记录手术时间、术中出血量、椎弓根螺钉置入的放射次数、术后引流量及下床活动时间。术后通过CT检查螺钉位置。所有患者均为女性,平均年龄(70.3±8.4)岁(56-84岁);患者随访12-16周。9例患者临床效果均良好。术后第3天及末次随访时的腰痛VAS评分均显著低于术前[(2.9±0.6)、(1.8±0.4)分 vs (6.4±1.1)分,均<0.05]。术后第3天及末次随访时的腿痛VAS评分均显著低于术前[(1.9±0.3)、(1.4±0.5)分 vs (7.3±1.6)分,<0.05]。末次随访时的ODI评分显著低于术前((24.0%±6.5% vs 55.7%±12.8%,<0.05)。术中出血量为(177±103)ml,术后引流量为(122±56)ml,手术时间为(207.8±32.7)min,下床活动时间为(2.3±0.5)天。椎弓根螺钉置入的总放射次数为20-42次,每枚螺钉平均放射次数为(6.9±1.5)次。未发生严重并发症或不良事件。手术中未发生神经根损伤或硬膜撕裂,无需翻修手术。双门内镜技术辅助下的椎弓根螺钉置入术在BE-LIF过程中可减少放射暴露,具有良好的可行性和安全性。BE-LIF联合双门内镜辅助下椎弓根螺钉置入术是治疗腰椎管狭窄症的一种有效、安全的手术方法,早期效果良好。