Chen Kang, Luo Yuan-Chao, Yang Fu-Guo, He Ren-Jian
Derpartment of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China.
Zhongguo Gu Shang. 2024 Apr 25;37(4):338-44. doi: 10.12200/j.issn.1003-0034.20221359.
To prospectively compare the clinical efficacy and radiographic outcomes between interlaminar percutaneous endoscopic lumbar decompression(IL-PELD) and transforaminar percutaneous endoscopic lumbar decompression(TF-PELD) in the treatment of single-segment lumbar lateral recess stenosis.
From April 2018 to July 2021, 85 patients with single-segment lumbar lateral recess stenosis underment percutaneous endoscopic lumbar decompression.There were 44 males and 41 females, aged from 49 to 81 years old with an average of (65.5±8.3) years old, duration of lumbar lateral recess stenosis ranging from 3 to 83 months with an average of (26.7±16.5) months. They were divided into IL-PELD group and TF-PELD group according to the different operation methods. There were 47 patients in the IL-PELD group, including 28 males and 19 females aged from 50 to 80 yeaes old with an average age was (66.7±9.3) years old. The disease duration ranged from 3 to 65 months with an average of (25.7±15.0) months. There were 38 patients in the TF-PELD group, including 16 males and 22 females, aged from 51 to 78 years old with an average of(64.1±7.6) years old. The disease duration ranged from 4 to 73 months with an average of (27.9±18.3) months The operation time, intraoperative blood loss, intraoperative fluoroscopy, hospitalization day and complications of the two groups were recorded. Visual analogue scale (VAS) to evaluate low back pain and lower limb pain, Oswestry disability index(ODI) to evaluate lumbar function in preoperative and postoperative period(1month, 6 months and last follow-up)were recorded. the sagittal diameter of the lateral recess of the responsible intervertebral space in preoperative and 1 week after the operation were recorded.
The operation was successfully completed in both groups without serious complications such as vascular injury, dural sac tear and nerve injury. The operation time in IL-PED group(69.3±19.3)min was significantly longer than that in TF-PELD group(57.5±14.5)min (<0.05). There was no significant difference in the intraoperative blood loss between the two groups (>0.05). The number of intraoperative fluoroscopy in TF-PELD group (8.8±2.6)times was significantly higher than that in IL-PED group(4.8±1.2)times (<0.05). The hospitalization days of the two groups were not statistically significant (>0.05). VAS for low back and lower extremity pain and ODI were (5.1±2.2), (6.9±1.3) scores and (71.4±12.6) % in IL-PELD group, and (4.7±1.8), (6.9±1.3) scores and (68.4±13.9)% in TF-PELD group. In the IL-PELD group, the VAS of low back pain was (2.4±1.5), (1.6±0.8), (1.4±0.9) scores, and the VAS of lower extremity pain was (3.0±1.2), (1.6±0.7), (1.5±1.0) scores, ODI was (32.6±11.9) %, (17.4±6.5) %, (19.3±9.3)%;In TF-PELD group, the VAS of low back pain was (2.6±1.4), (1.5±0.6), (1.4±1.0) scores, and the VAS of lower extremity pain was (2.8±1.2), (1.6±0.6), (1.5±1.2) scores, The ODI was (32.0±11.2) %, (15.0±6.1) %, and (20.0±11.3) %. The VAS and ODI of the two groups at each time point after operation were significantly improved compared with those before operation (<0.05), but there was no statistically significant difference between the groups (>0.05), and there was no statistically significant difference in the interaction between different time points and groups (>0.05). At 1 week after operation, the sagittal diameter of lateral recess in both groups was significantly increased compared with that before operation (<0.05), but there was no significant difference between the two groups at each time point (>0.05). According to the modified Macnab criteria, IL-PELD group was rated as excellent in 24 cases, good in 19 cases and fair in 4 cases. In TF-PELD group the results were excellent in 19 cases, good in 15 cases, fair in 3 cases and poor in 1 case. There was no significant difference between the two groups (>0.05).
IL-PELD and TF-PELD can expand the lateral recess in the treatment of single level lumbar lateral recess stenosis, and have achieved good clinical effects.
前瞻性比较椎板间入路经皮内镜下腰椎减压术（IL-PELD）与椎间孔入路经皮内镜下腰椎减压术（TF-PELD）治疗单节段腰椎侧隐窝狭窄症的临床疗效及影像学结果。
2018年4月至2021年7月，85例单节段腰椎侧隐窝狭窄症患者接受了经皮内镜下腰椎减压术。其中男性44例，女性41例，年龄49至81岁，平均（65.5±8.3）岁，腰椎侧隐窝狭窄病程3至83个月，平均（26.7±16.5）个月。根据手术方式不同将其分为IL-PELD组和TF-PELD组。IL-PELD组47例，其中男性28例，女性19例，年龄50至80岁，平均年龄（66.7±9.3）岁。病程3至65个月，平均（25.7±15.0）个月。TF-PELD组38例，其中男性16例，女性22例，年龄51至78岁，平均（64.1±7.6）岁。病程4至73个月，平均（27.9±18.3）个月。记录两组患者的手术时间、术中出血量、术中透视次数、住院天数及并发症情况。采用视觉模拟评分法（VAS）评估术前及术后（1个月、6个月及末次随访）的腰痛及下肢疼痛情况，采用Oswestry功能障碍指数（ODI）评估腰椎功能。记录术前及术后1周责任椎间隙侧隐窝矢状径。
两组手术均顺利完成，未发生血管损伤、硬脊膜囊撕裂及神经损伤等严重并发症。IL-PELD组手术时间（69.3±19.3）分钟，显著长于TF-PELD组（57.5±14.5）分钟（<0.05）。两组术中出血量差异无统计学意义（>0.05）。TF-PELD组术中透视次数（8.8±2.6）次，显著多于IL-PELD组（4.8±1.2）次（<0.05）。两组住院天数差异无统计学意义（>0.05）。IL-PELD组腰痛及下肢疼痛VAS评分及ODI分别为（5.1±2.2）、（6.9±1.3）分及（71.4±12.6）%，TF-PELD组分别为（4.7±1.8）、（6.9±1.3）分及（68.4±13.9）%。IL-PELD组术后腰痛VAS评分分别为（2.4±1.5）、（1.6±0.8）、（1.4±0.9）分，下肢疼痛VAS评分分别为（3.0±1.2）、（1.6±0.7）、（1.5±1.0）分，ODI分别为（32.6±11.9）%、（17.4±6.5）%、（19.3±9.3）%；TF-PELD组术后腰痛VAS评分分别为（2.6±1.4）、（1.5±0.6）、（1.4±1.0）分，下肢疼痛VAS评分分别为（2.8±1.2）、（1.6±0.6）、（1.5±1.2）分，ODI分别为（32.
