Vande Kerckhove Michiel, d'Astorg Henri, Ramos-Pascual Sonia, Saffarini Mo, Fiere Vincent, Szadkowski Marc
Ramsay Santé, Hôpital Privé Jean Mermoz, Orthopédique Santy, Lyon, France.
ReSurg SA, Nyon, Switzerland.
EFORT Open Rev. 2023 Feb 21;8(2):73-89. doi: 10.1530/EOR-22-0093.
This study aimed to systematically review the literature for comparative and non-comparative studies reporting on clinical outcomes of patients with lumbar foraminal stenosis treated by either endoscopic foraminotomy or fusion.
In adherence with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a literature search was done on January 17, 2022, using Medline and Embase. Clinical studies were eligible if they reported outcomes following fusion or endoscopic foraminotomy, in patients with primary lumbar foraminal stenosis. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist.
The search returned 827 records; 266 were duplicates, 538 were excluded after title/abstract/full-text screening, and 23 were eligible, with 16 case series reporting on endoscopic foraminotomy, 7 case series reporting on fusion, and no comparative studies. The JBI checklist indicated that 21 studies scored ≥4 points. When comparing endoscopic foraminotomy to fusion, pooled data revealed reduced operative time (69 vs 119 min, P < 0.01) but similar Oswestry disability index (19 vs 20, P = 0.67), lower back pain (2 vs 2, P = 0.11), leg pain (2 vs 2, P = 0.15), complication rates (10% vs 5%, P = 0.22), and reoperation rates (5% vs 0%, P = 0.16). The proportions of patients with good/excellent MacNab criteria were similar for endoscopic foraminotomy and fusion (82-91% vs 85-91%).
There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.
本研究旨在系统回顾有关采用内镜下椎间孔切开术或融合术治疗腰椎椎间孔狭窄症患者临床结局的比较性和非比较性研究的文献。
按照系统评价和Meta分析的首选报告项目指南，于2022年1月17日使用Medline和Embase进行文献检索。如果临床研究报告了原发性腰椎椎间孔狭窄症患者接受融合术或内镜下椎间孔切开术后的结局，则这些研究符合纳入标准。两名独立的审阅者筛选标题、摘要和全文以确定是否符合纳入标准；进行数据提取；并根据乔安娜·布里格斯研究所（JBI）清单评估符合条件的研究的质量。
检索共返回827条记录；266条为重复记录，538条在标题/摘要/全文筛选后被排除，23条符合条件，其中16个病例系列报告了内镜下椎间孔切开术，7个病例系列报告了融合术，且无比较性研究。JBI清单显示，21项研究得分≥4分。将内镜下椎间孔切开术与融合术进行比较时，汇总数据显示手术时间缩短（69分钟对119分钟，P<0.01），但奥斯威斯利功能障碍指数相似（19对20，P=0.67），下背痛（2对2，P=0.11），腿痛（2对2，P=0.15），并发症发生率（10%对5%，P=0.22）和再次手术率（5%对0%，P=0.16）。内镜下椎间孔切开术和融合术符合MacNab标准优/良的患者比例相似（82-91%对85-91%）。
内镜下椎间孔切开术和融合术治疗腰椎椎间孔狭窄症在临床结局、并发症发生率和再次手术率方面存在高度异质性且无显著差异；尽管内镜下椎间孔切开术的手术时间缩短。
