Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.
Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
J Orthop Surg Res. 2023 Mar 9;18(1):183. doi: 10.1186/s13018-023-03676-x.
Various lumbar decompression techniques have been used for the treatment of degenerative lumbar spondylolisthesis (DLS). Few studies have compared the clinical efficacy of percutaneous transforaminal endoscopic decompression (PTED) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lateral recess stenosis associated with DLS (LRS-DLS) in geriatric patients. The objective of the study was to compare the safety and short-term clinical efficacy of 270-degree PTED under local anesthesia and MIS-TLIF in the treatment of LRS-DLS in Chinese geriatric patients over 60 years old.
From January 2017 to August 2019, the data of 90 consecutive geriatric patients with single-level L4-5 LRS-DLS were retrospectively reviewed, including those in the PTED group (n = 44) and MIS-TLIF group (n = 46). The patients were followed up for at least 1 year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. X-ray examinations were performed 1 year after surgery to assess the progression of spondylolisthesis in the PTED group and bone fusion in the MIS-TLIF group.
The mean patient ages in the PTED and MIS-TLIF groups were 70.3 years and 68.6 years, respectively. Both the PTED and MIS-TLIF groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time point (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the PTED group was similar to that in the MIS-TLIF group (90.9% vs. 91.3%, P > 0.05), PTED was advantageous in terms of the operative time, estimated blood loss, incision length, drainage time, drainage volume, length of hospital stay, and complications.
Both PTED and MIS-TLIF led to favorable outcomes in geriatric patients with LRS-DLS. In addition, PTED caused less severe trauma and fewer complications. In terms of perioperative quality-of-life and clinical outcomes, PTED could supplement MIS-TLIF in geriatric patients with LRS-DLS.
各种腰椎减压技术已被用于治疗退行性腰椎滑脱症（DLS）。很少有研究比较经皮经椎间孔内镜减压术（PTED）和微创经椎间孔腰椎椎间融合术（MIS-TLIF）在治疗老年患者伴 DLS 的侧隐窝狭窄（LRS-DLS）方面的临床疗效。本研究的目的是比较局部麻醉下 270°PTED 和 MIS-TLIF 治疗中国 60 岁以上老年患者单节段 L4-5 LRS-DLS 的安全性和短期临床疗效。
回顾性分析 2017 年 1 月至 2019 年 8 月连续 90 例老年单节段 L4-5 LRS-DLS 患者的临床资料，其中 PTED 组 44 例，MIS-TLIF 组 46 例。所有患者均至少随访 1 年。分别比较术前和术后患者的人口统计学和围手术期结果。采用 Oswestry 功能障碍指数（ODI）、腿痛视觉模拟评分（VAS）和改良 MacNab 标准评估临床疗效。术后 1 年行 X 线检查评估 PTED 组滑脱进展和 MIS-TLIF 组骨融合情况。
PTED 组和 MIS-TLIF 组患者的平均年龄分别为 70.3 岁和 68.6 岁。PTED 组和 MIS-TLIF 组患者的腿痛 VAS 评分和 ODI 评分均明显改善，且各时间点两组间比较差异均无统计学意义（P>0.05）。PTED 组改良 MacNab 标准优良率与 MIS-TLIF 组相似（90.9%比 91.3%，P>0.05），但 PTED 在手术时间、估计失血量、切口长度、引流时间、引流量、住院时间和并发症方面具有优势。
PTED 和 MIS-TLIF 均能为老年 LRS-DLS 患者带来良好的治疗效果。此外，PTED 造成的创伤较小，并发症较少。在围手术期生活质量和临床疗效方面，PTED 可作为老年 LRS-DLS 患者的 MIS-TLIF 补充治疗。
