Watanabe Seiya, Nakanishi Kazuo, Sato Ryo, Sugimoto Yoshihisa, Mitani Shigeru
Orthopedics, Kawasaki Medical School, Okayama, JPN.
Cureus. 2024 May 2;16(5):e59509. doi: 10.7759/cureus.59509. eCollection 2024 May.
Objective The elderly population is increasing in Japan. Along with the increase in the elderly population, the number of patients with lumbar degenerative diseases is also on the rise. In general, elderly patients tend to have more complications and are at higher risk for surgery. Many elderly people suffer from lumbar degenerative disease. We reviewed our initial experience with trans-sacral canal plasty (TSCP) for patients with lumbar spinal canal stenosis and examined the pertinent literature for this report. Methods An analytical observational study was performed on 120 patients with lumbar spinal canal stenosis who underwent TSCP at our single institution from March 2019 to October 2021. These patients had leg pain and/or lower back pain due to degenerative lumbar disease. Patients who had coagulation abnormality, pregnancy, contrast allergy, pyogenic spondylitis, or spinal metastasis were excluded. Results Immediately after TSCP, the average Visual Analog Scale (VAS) score for back pain improved from 58.2 to 29.3, and for leg pain from 72.0 to 31.3. Two years after TSCP, the average VAS score for back pain increased slightly and the average score for leg pain remained almost the same. Additional surgery was performed in 37 of 120 (31%) patients who underwent TSCP. The additional surgery group had significantly worse back pain at one and three months postoperatively than the conservative treatment group. The additional surgery group had significantly worse leg pain immediately after TSCP and at one and three months postoperatively than the conservative treatment group. Logistic regression analysis demonstrated that a decreased spinal canal area (OR 0.986, p = 0.039) was associated with additional surgery. Conclusions We reviewed the outcomes of TSCP at our hospital. The average VAS score for back pain and leg pain improved. However, 31% of patients who underwent TSCP required additional surgery. It was found that the spinal canal area was a major factor in the need for additional surgery.
目的 日本老年人口正在增加。随着老年人口的增加，腰椎退行性疾病患者的数量也在上升。一般来说，老年患者往往有更多并发症，手术风险更高。许多老年人患有腰椎退行性疾病。我们回顾了经骶管成形术（TSCP）治疗腰椎管狭窄症患者的初步经验，并查阅了相关文献以撰写本报告。方法 对2019年3月至2021年10月在我们单一机构接受TSCP的120例腰椎管狭窄症患者进行了分析性观察研究。这些患者因退行性腰椎疾病而有腿痛和/或腰痛。排除有凝血异常、妊娠、造影剂过敏、化脓性脊柱炎或脊柱转移的患者。结果 TSCP术后即刻，背痛的平均视觉模拟评分（VAS）从58.2改善至29.3，腿痛从72.0改善至31.3。TSCP术后两年，背痛的平均VAS评分略有增加，腿痛的平均评分几乎保持不变。120例接受TSCP的患者中有37例（31%）进行了二次手术。二次手术组术后1个月和3个月的背痛明显比保守治疗组更严重。二次手术组在TSCP术后即刻以及术后1个月和3个月的腿痛明显比保守治疗组更严重。逻辑回归分析表明，椎管面积减小（OR 0.986，p = 0.039）与二次手术相关。结论 我们回顾了我院TSCP的治疗结果。背痛和腿痛的平均VAS评分有所改善。然而，31%接受TSCP的患者需要二次手术。发现椎管面积是需要二次手术的主要因素。
