Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
Spine J. 2024 Jun;24(6):1022-1033. doi: 10.1016/j.spinee.2023.12.009. Epub 2024 Jan 6.
Symptomatic lumbar spinal stenosis is routinely treated with spinal decompression surgery, with an increasing trend towards minimally invasive techniques. Endoscopic decompression has emerged as a technique which minimizes approach-related morbidity while achieving similar clinical outcomes to conventional open or microscopic approaches.
To assess the safety and efficacy of endoscopic versus microscopic decompression for treatment of lumbar spinal stenosis.
Systematic review and meta-analysis.
A systematic review on randomized and nonrandomized studies comparing endoscopic versus microscopic decompression was conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Treatment effects were computed using pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk-of-bias and ROBINS-I tools for randomized and nonrandomized trials respectively. Quality of the overall body of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
A total of 19 primary references comprising 1,997 patients and 2,132 spinal levels were included. Endoscopic decompression was associated with significantly reduced intraoperative blood-loss (weighted mean differences [WMD]=-33.29 mL, 95% CI:-51.80 to -14.78, p=.0032), shorter duration of hospital stay (WMD=-1.79 days, 95% CI: -2.63 to 0.95, p=.001), rates of incidental durotomy (RR = 0.63, 95% CI: 0.43 to 0.91, p=.0184) and surgical site infections (RR=0.23, 95% CI: 0.10 to-0.51, p=.001), and a nonsignificant trend towards less back pain, leg pain, and better functional outcomes compared to its microscopic counterpart up to 2-year follow up.
Endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar spinal stenosis. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to compare potential alignment changes and destabilization from either techniques.
有症状的腰椎管狭窄症通常采用脊柱减压手术治疗，微创手术的趋势日益增加。内窥镜减压术已成为一种技术，它最大限度地减少了与入路相关的发病率，同时达到了与传统开放或显微镜入路相似的临床效果。
评估内镜与显微镜减压治疗腰椎管狭窄症的安全性和疗效。
系统回顾和荟萃分析。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对比较内镜与显微镜减压的随机和非随机研究进行了系统回顾。使用成对随机效应荟萃分析计算治疗效果。使用 Cochrane 风险偏倚和 ROBINS-I 工具分别评估随机和非随机试验的风险偏倚。使用推荐评估、制定和评估（GRADE）系统评估总体证据质量。
共纳入 19 篇主要参考文献，包括 1997 例患者和 2132 个脊柱水平。内窥镜减压术与术中失血量显著减少相关（加权均数差[WMD]=-33.29 毫升，95%置信区间：-51.80 至-14.78，p=.0032），住院时间缩短（WMD=-1.79 天，95%置信区间：-2.63 至 0.95，p=.001），偶然硬脊膜切开术（RR = 0.63，95%置信区间：0.43 至 0.91，p=.0184）和手术部位感染（RR=0.23，95%置信区间：0.10 至 0.51，p=.001）的发生率较低，与显微镜减压术相比，在 2 年随访时背部疼痛、腿部疼痛和更好的功能结果呈显著趋势。
内镜和显微镜减压术是治疗有症状的腰椎管狭窄症的安全有效技术。需要进行更大功率的前瞻性研究，考虑中至长期结果和医源性不稳定的发生率，以比较两种技术的潜在对线变化和失稳。
