Patgaonkar Prasad, Goyal Vaibhav, Patel Pratik, Dhole Kiran, Ravi Achyut, Patel Vivek, Borole Pushkar
Indore Spine Centre, 5-6 RS Bhandari Marg, Indore, Madhya Pradesh 452009, India.
N Am Spine Soc J. 2023 Jul 16;15:100244. doi: 10.1016/j.xnsj.2023.100244. eCollection 2023 Sep.
Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and high chances of inadequate decompression, iatrogenic instability, dural tear, or dysesthesia. Hence authors propose a new surgical nomenclature and algorithm for selection of endoscopic approach.
This retrospective study included 396 of 626 consecutive patients who met the inclusion criteria, who underwent either TF (n=302) or IL (n=202) full endoscopic spine surgery. MRI findings of every patient were classified as per FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm. Inter-observer variations were calculated. The targeted nomenclature was used to define the selection of endoscopic TF or IL approach for symptomatic nerve root decompression. All patients were followed up for preop and postop 6 months VAS and Oswestry Disability Index score for validation of FAPDIS algorithm.
Median age: 46.8 years; Sides and levels operated 330 single-level ipsilateral, 54 multiple-level ipsilateral, 6 single-level bilateral, and 6 multiple-level bilateral. Interobserver agreement in the selection of TF approach was 0.873 and IL approach was 0.882. Interobserver variability was also calculated for each FAPDIS factor, selection of P3 and P4 pathology was the main reason for disagreement. All other FAPDIS factors show good to excellent correlation. The overall VAS score decreased from a preoperative value of 9 to 1 at 6 months follow-up (p-value < 0.001), and the overall Oswestry Disability Index score improved from 89 to 12 (p-value <.001).
The author's new FAPDIS surgical nomenclature and algorithm is a reliable tool for describing the symptomatic nerve root compression for the selection of endoscopic surgical approach to achieve adequate decompression of offending neural structure with minimum challenges to minimize perioperative complication rate.
经椎间孔（TF）和椎板间（IL）内镜入路都是治疗腰椎压迫性神经根病的成熟减压技术。由于缺乏足够的文献资料，在内镜减压入路的选择上总是存在一些两难境地，这导致学习曲线较长，减压不充分、医源性不稳定、硬脊膜撕裂或感觉异常的可能性较高。因此，作者提出了一种新的手术命名法和内镜入路选择算法。
这项回顾性研究纳入了626例连续患者中的396例符合纳入标准的患者，这些患者接受了TF（n = 302）或IL（n = 202）全内镜脊柱手术。根据FAPDIS（关节突角、前方病变、后方病变、背侧、下方和上方移位）算法对每位患者的MRI结果进行分类。计算观察者间的差异。使用目标命名法来定义内镜TF或IL入路用于症状性神经根减压的选择。所有患者均接受术前和术后6个月的VAS和Oswestry功能障碍指数评分，以验证FAPDIS算法。
中位年龄：46.8岁；手术的侧别和节段：330例单节段同侧、54例多节段同侧、6例单节段双侧和6例多节段双侧。TF入路选择的观察者间一致性为0.873，IL入路为0.882。还计算了每个FAPDIS因素的观察者间变异性，P3和P4病变的选择是分歧的主要原因。所有其他FAPDIS因素显示出良好至极好的相关性。总体VAS评分从术前的9分降至随访6个月时的1分（p值<0.001），总体Oswestry功能障碍指数评分从89分提高到12分（p值<0.001）。
作者新的FAPDIS手术命名法和算法是一种可靠的工具，用于描述症状性神经根压迫，以选择内镜手术入路，从而在最小挑战下实现对病变神经结构的充分减压，以尽量降低围手术期并发症发生率。
