Murata Shizumasa, Nagata Keiji, Iwasaki Hiroshi, Hashizume Hiroshi, Yukawa Yasutsugu, Minamide Akihito, Nakagawa Yukihiro, Tsutsui Shunji, Takami Masanari, Taiji Ryo, Kozaki Takuhei, J Schoenfeld Andrew, K Simpson Andrew, Yoshida Munehito, Yamada Hiroshi
Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko, Japan.
Spine Surg Relat Res. 2022 Feb 10;6(5):488-496. doi: 10.22603/ssrr.2021-0200. eCollection 2022 Sep 27.
Long-term clinical outcomes of microendoscopic laminotomy (MEL) for patients with multilevel radiographic lumbar spinal canal stenosis (LSS) have not been widely explored. The clinical significance and natural progression of additional untreated levels (e.g., remaining radiographic (RR)-LSS not addressed by selective MEL) remain unknown. This retrospective study aimed to investigate the long-term clinical outcomes of selective MEL in LSS patients and compare outcomes between patients with and without remaining RR-LSS to determine the efficacy of this procedure.
Forty-nine patients at a single center underwent posterior spinal microendoscopic decompression surgery for neurogenic claudication or radicular leg pain in moderate-to-severe spinal stenosis. The patients were categorized into the RR-LSS-positive and RR-LSS-negative cohorts based on unaddressed levels of stenosis. Pre-operative and 10-year follow-up evaluations, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score for low back pain and leg pain, Oswestry Disability Index (ODI), and satisfaction, were compared between the groups. Additionally, the need for reoperation was determined.
MEL significantly improved JOA scores, lumbar VAS, and ODI over the 10-year postoperative period. Pre-operative characteristics and postoperative outcomes were not significantly different between the cohorts. Overall, 18.4% (9/49) of patients required reoperation during the follow-up period. The reoperation rate in the RR-LSS-positive (13.8%; 4/29) group was similar to that in the RR-LL-negative (15.0%; 3/20) group.
MEL is effective for lumbar stenosis, with improved clinical outcomes up to 10 years following surgery. Selective MEL, addressing only symptomatic levels in multilevel stenosis, with residual remaining lumbar stenosis, is similarly effective without increased reoperation rates. Surgeons may consider more limited selective decompression in patients with multilevel stenosis, avoiding the risk and invasiveness of extensive procedures.
Level III.
对于多节段影像学腰椎管狭窄症（LSS）患者，微内镜下椎板切除术（MEL）的长期临床疗效尚未得到广泛研究。额外未治疗节段（例如，选择性MEL未处理的剩余影像学（RR）-LSS）的临床意义和自然进展仍不清楚。这项回顾性研究旨在调查LSS患者选择性MEL的长期临床疗效，并比较有和没有剩余RR-LSS患者的疗效，以确定该手术的有效性。
在单一中心，49例患者因中重度椎管狭窄导致神经源性间歇性跛行或根性腿痛接受了后路脊柱微内镜减压手术。根据未处理的狭窄节段，将患者分为RR-LSS阳性和RR-LSS阴性队列。比较两组术前和10年随访评估结果，包括日本骨科协会（JOA）评分、腰痛和腿痛的视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）和满意度。此外，确定再次手术的必要性。
在术后10年期间，MEL显著改善了JOA评分、腰椎VAS和ODI。两组术前特征和术后结果无显著差异。总体而言，18.4%（9/49）的患者在随访期间需要再次手术。RR-LSS阳性组（13.8%；4/29）的再次手术率与RR-LSS阴性组（15.0%；3/20）相似。
MEL对腰椎管狭窄有效，术后10年临床疗效改善。选择性MEL仅处理多节段狭窄的症状性节段，存在残留腰椎管狭窄，同样有效且不增加再次手术率。外科医生可考虑对多节段狭窄患者进行更有限的选择性减压，避免广泛手术的风险和侵袭性。
三级。
