Sriphirom Pornpavit, Siramanakul Chaiyaporn, Sumritsopak Manoch, Chokviriyaprasert Parinya, Uttamo Nantawat, Songchou Kittinon
Department of Orthopaedic Surgery, Rajavithi Hospital, Rangsit University, Bangkok, Thailand.
Department of Orthopaedic Surgery, Paolo Phaholyothin Hospital, Bangkok, Thailand
Int J Spine Surg. 2023 Jun;17(3):335-342. doi: 10.14444/8413. Epub 2022 Dec 13.
To evaluate the clinical and radiological outcomes of a novel full endoscopic procedure performed via an interlaminar approach to decompress entrapped nerve roots in patients with lumbar spondylolysis.
Patients who underwent interlaminar percutaneous endoscopic pars decompression were included in this retrospective cohort study. Patients with back pain and dynamic lumbar instability were excluded from the study. Clinical parameters related to outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain, were assessed before and after surgery. The radiological outcomes, vertebral slippage percentage, and motion radiographs were evaluated preoperatively and postoperatively.
Of the 11 patients included in the study, 5 had spondylolysis alone, 1 of whom had spondylolysis at L3-L4 and L4-L5, and 4 of whom had it at L5-S1; and 6 patients had spondylolysis in combination with spondylolisthesis, of whom 4 had involvement at L5-S1, 1 had involvement at L4-L5, and 1 had involvement at L3-L4. At a mean follow-up period of 22.64 months, 63.3% of patients achieved more than 50% improvement in ODI score and 90.91% of patients achieved more than 50% improvement in VAS score. Spondylolysis with vertebral slippage had inferior ODI improvement outcomes as compared with spondylolysis alone, but the VAS was not significantly different. No significant difference was observed on the slippage percentage observed between the pre- and postoperative periods. However, 1 patient experienced vertebral slippage after surgery, but fusion surgery was not required.
Interlaminar percutaneous endoscopic pars decompression is a safe and successful treatment for patients with stable lumbar spondylolysis and nerve root compression. Even in situations in which vertebral slippage occurs, spinal fusion may not be the best option for all patients with lumbar spondylolysis.
The interlaminar percutaneous endoscopic pars decompression is a safe and successful procedure for treatment of patients with stable lumbar spondylolysis and nerve root compression.
评估一种新型全内镜下经椎板间入路减压治疗腰椎峡部裂患者受压神经根的临床和影像学效果。
本回顾性队列研究纳入接受经椎板间经皮内镜下峡部减压的患者。背痛和动态腰椎不稳患者被排除在研究之外。评估术前和术后与疗效相关的临床参数，包括Oswestry功能障碍指数（ODI）和腿痛视觉模拟量表（VAS）。术前和术后评估影像学结果、椎体滑脱百分比和动态X线片。
研究纳入的11例患者中，5例单纯峡部裂，其中1例L3-L4和L4-L5均有峡部裂，4例L5-S1有峡部裂；6例峡部裂合并椎体滑脱，其中4例L5-S1受累，1例L4-L5受累，1例L3-L4受累。平均随访22.64个月时，63.3%的患者ODI评分改善超过50%，90.91%的患者VAS评分改善超过50%。与单纯峡部裂相比，峡部裂合并椎体滑脱的ODI改善效果较差，但VAS无显著差异。术前和术后观察到的滑脱百分比无显著差异。然而，1例患者术后出现椎体滑脱，但无需进行融合手术。
经椎板间经皮内镜下峡部减压是治疗稳定型腰椎峡部裂和神经根受压患者的一种安全且成功的治疗方法。即使在出现椎体滑脱的情况下，脊柱融合术可能并非所有腰椎峡部裂患者的最佳选择。
经椎板间经皮内镜下峡部减压是治疗稳定型腰椎峡部裂和神经根受压患者的一种安全且成功的手术。
