Wu Pang Hung, Lau Eugene Tze-Chun, Kim Hyeun-Sung, Grasso Giovanni, Jang Il-Tae
National University Health System, Juronghealth Campus, Department of Orthopaedic Surgery, Singapore.
Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy.
Neurospine. 2023 Mar;20(1):99-109. doi: 10.14245/ns.2346132.066. Epub 2023 Mar 31.
There is a lack of literature on indirect decompression in uniportal endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF). Our aim is to evaluate the dimensions of the spinal canal and contralateral foramen before and after EPTLIF.
This is a retrospective study of patients who underwent EPTLIF in a tertiary spine centre over a 2-year period. The cross-sectional area of the spinal canal and the contralateral foramen at the level of fusion were measured on magnetic resonance imaging scan at 1-day postoperation and at the final follow-up. Patients were grouped according to the decompression performed as per the clinician's judgement.
One hundred fifty-two levels of fusion were performed in 120 patients. There was a statistically significant clinical improvement in visual analogue scale and Oswestry Disability Index scores postoperation. The measurements of the spinal canal area were 106.0 mm2, 138.8 mm2, and 195.5 mm2; while contralateral foraminal area were 73.2 mm2, 104.4 mm2, and 120.7 mm2 at preoperation, 1-day postoperation, and at the final follow-up, respectively (p < 0.001). For the subgroup analyses, spinal canal area measurements for the bilateral decompression cohort (n = 35) were 57.0 mm2, 123.9 mm2, and 191.8 mm2; for the ipsilateral decompression cohort (n = 42) were 89.3 mm2, 128.9 mm2, 183.3 mm2; and for the cohort without any decompression and only cage inserted (n = 75) were 138.3 mm2, 151.2 mm2, and 204.1 mm2 (p < 0.001). Contralateral foraminal area measurements were 73.3 mm2, 106.4 mm2 and 120.4 mm2 in the bilateral decompression cohort; 69.5 mm2, 99.0 mm2, 116.9 mm2 in the ipsilateral decompression cohort; and 75.1 mm2, 106.5 mm2, 122.9 mm2 in the cohort without any decompression (p < 0.001).
Indirect decompression of both the spinal canal and the contralateral foramen can be achieved via EPTLIF. Decompression on an asymptomatic contralateral side is not necessary.
关于单孔内镜下后外侧经椎间孔腰椎椎间融合术（EPTLIF）中间接减压的文献较少。我们的目的是评估EPTLIF术前和术后椎管及对侧椎间孔的尺寸。
这是一项对在一家三级脊柱中心接受EPTLIF手术的患者进行的为期2年的回顾性研究。在术后1天和最终随访时，通过磁共振成像扫描测量融合节段椎管和对侧椎间孔的横截面积。根据临床医生的判断将患者按减压方式分组。
120例患者共进行了152个节段的融合。术后视觉模拟评分和Oswestry功能障碍指数评分有统计学意义的临床改善。术前、术后1天和最终随访时椎管面积测量值分别为106.0mm²、138.8mm²和195.5mm²；对侧椎间孔面积分别为73.2mm²、104.4mm²和120.7mm²（p<0.001）。亚组分析中，双侧减压组（n = 35）的椎管面积测量值为57.0mm²、123.9mm²和191.8mm²；同侧减压组（n = 42）为89.3mm²、128.9mm²、183.3mm²；未进行任何减压仅植入椎间融合器组（n = 75）为138.3mm²、151.2mm²和204.1mm²（p<0.001）。对侧椎间孔面积测量值在双侧减压组为73.3mm²、106.4mm²和120.4mm²；同侧减压组为69.5mm²、99.0mm²、116.9mm²；未减压组为75.1mm²、106.5mm²、122.9mm²（p<0.001）。
通过EPTLIF可实现椎管和对侧椎间孔的间接减压。对无症状的对侧进行减压没有必要。
