Cao Zheng, Li Zhenzhou, Zhao Hongliang, Wang Jinchang, Hou Shuxun
Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing 100048, China.
Bioengineering (Basel). 2023 Sep 19;10(9):1097. doi: 10.3390/bioengineering10091097.
Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative ( < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.
老年人在接受后路腰椎融合内固定术（PILF）后进行翻修手术时，通常手术耐受性较差且并发症发生率较高。全内镜经椎间孔手术是一种安全有效的选择，但有时，PILF术后翻修L5 - S1椎间孔狭窄（FS）较为困难。因此，我们在局部麻醉下通过改良的椎板间入路在融合节段开展了全内镜下腰椎减压术（FELD）。本研究旨在描述该技术的操作要点及临床疗效。11例PILF术后出现单侧下肢神经根病的患者接受了选择性神经根阻滞，然后接受了FELD。术后第二天进行了磁共振成像（MRI）和计算机断层扫描（CT）。采用腰痛和坐骨神经痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和MacNab评分对其临床结果进行评估。FELD在每例患者中均实现了完全减压，且无严重并发症。与术前相比，术后各时间点的坐骨神经痛VAS和ODI以及术后三个月的腰痛VAS和ODI均有显著改善（<0.05）。根据MacNab标准，在两年随访时，7例患者（63.6%）结果为优，4例患者（36.4%）结果为良。无患者需要进一步的翻修手术。通过改良椎板间入路的FELD对治疗老年人PILF术后单侧L5 - S1 FS有效。
