Dou Ning-Ning, Wang Hao-Lin, Hu Shao-Zhen, Huang Zheng-Nan, Zhong Jun, Li Shi-Ting
Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China.
Neurospine. 2023 Sep;20(3):1040-1046. doi: 10.14245/ns.2346624.312. Epub 2023 Sep 30.
Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis.
Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed.
A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05 ± 12.18 minutes) was shorter than that in the drill group (134.67 ± 9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients.
Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.
尽管内镜钻在操作和止血方面具有优势，但其效率低下和视野模糊降低了腰椎内镜下单侧椎板切开双侧减压术（LE-ULBD）的疗效。本研究旨在评估全可视化环锯/骨刀在重度腰椎管狭窄症LE-ULBD手术中的安全性和有效性。
纳入2020年1月至2023年1月期间接受LE-ULBD手术的57例重度腰椎管狭窄症患者，分为钻组和可视化环锯组。回顾性分析两组患者的病历资料，包括人口统计学资料、手术时间、术中电生理检查结果、术后住院时间、术后疗效及并发症等。
本研究共纳入57例患者，其中钻组15例，环锯组42例。两组患者术前和术后视觉模拟评分及Oswestry功能障碍指数评分均有显著差异（p<0.05）。环锯组平均手术时间（101.05±12.18分钟）短于钻组（134.67±9.68分钟）（p<0.05）。两组在电生理监测、术后住院时间、术后疗效及并发症方面差异无统计学意义。钻组和环锯组分别有2例（13.3%）和5例（11.9%）患者记录到异常自由肌电图（EMG）。钻组和环锯组分别有3例（20%）和3例（7.1%）患者术中体感诱发电位发生变化，所有患者在手术结束后均立即恢复。所有患者均未发生严重并发症及复发。
本研究证实全可视化环锯/骨刀操作方便、安全、高效，联合经椎板由内向外技术及EMG监测尤其是自由EMG，可为腰椎管狭窄症患者的LE-ULBD手术提供新的选择。
