内镜减压手术治疗腰椎管狭窄症的疗效
Efficacy of endoscopic decompression surgery for treatment of lumbar spinal stenosis.
作者信息
Persaud-Sharma Dharam, Gunaratne Chamara, Talati Jay, Philips Will, Sohel Akib, Blake Andrew, Vasilopoulos Terrie, Kumar Sanjeev
机构信息
Penn State Hershey Milton Medical Center, Hershey, PA, 17033, USA.
University of Florida College of Medicine, Gainesville, FL, 32610, USA.
出版信息
Interv Pain Med. 2024 Feb 17;3(1):100391. doi: 10.1016/j.inpm.2024.100391. eCollection 2024 Mar.
BACKGROUND
The overall aim of this study was to assess the effectiveness of endoscopic decompression for outcomes in patients with lumbar spinal stenosis (LSS).
METHODS
We conducted a retrospective cohort, single-institution study of n = 139 patients from 2019 to 2022 who underwent endoscopic decompression for LSS. The primary outcome was improvement of Oswestry Disability Index (ODI) between baseline and 12-month follow-up.
RESULTS
In the present sample (n = 139) the average age was 57.6 years (SD = 17.4, with even distribution of men (49%) vs. women (51%). In patients with LSS, lumbar disc herniation was the most common diagnosis in 49 patients followed by lumbar radiculopathy in 25 patients. Lumbar radicular pain was the 3rd most common diagnosis in 21 patients with all other diagnosis listed in Table S1. There was a significant improvement (i.e., decrease) in ODI following endoscopic decompression (mean change: -8.3, 95% CI: -9.4, -7.2, < 0.001, Fig. 1). Prior lumbar spine surgery ( = 0.048), BMI ( = 0.053), and age ( = 0.022) were associated with changes in ODI. Nearly half (47%) of the sample had prior lumbar spine surgery. Those with prior lumbar spine surgery (-7.5, 95% CI: -8.3, -6.6) showed less improvement than those without prior lumbar spine surgery (-9.1, 95% CI: -10.9, -7.2, Fig. 2). For BMI, 23% had normal BMI while 24% were overweight and 53% were obese. Patients with normal BMI (-10.3, 95% CI: -13.4, -7.2) showed greater improvements compared to overweight (-7.9, 95% CI: -9.4, -6.4) and obese (-7.6, 95% CI: -9.0, -6.3, Fig. 3) patients. Patients under 40 years old (-10.2, 95% CI: -13.6, -6.8) showed greater improvements in ODI compared to those 40 years and older (-7.8, 95% CI: -8.6, -6.8, Fig. 4).
CONCLUSIONS
In patients with lumbar spinal stenosis, endoscopic decompression was associated with reduced disability. Patients with no prior lumbar spine surgery, normal BMI, and who were under 40 years old showed greater improvements.
背景
本研究的总体目标是评估内镜减压术对腰椎管狭窄症（LSS）患者治疗效果的有效性。
方法
我们进行了一项回顾性队列研究，该研究为单机构研究，纳入了2019年至2022年间接受内镜减压术治疗LSS的139例患者。主要结局指标是基线至12个月随访期间奥斯维斯特里功能障碍指数（ODI）的改善情况。
结果
在本样本（n = 139）中，平均年龄为57.6岁（标准差 = 17.4），男性（49%）和女性（51%）分布均匀。在LSS患者中，腰椎间盘突出症是最常见的诊断，有49例患者，其次是腰椎神经根病，有25例患者。腰神经根性疼痛是第三常见的诊断，有21例患者，所有其他诊断见表S1。内镜减压术后ODI有显著改善（即下降）（平均变化：-8.3，95%可信区间：-9.4，-7.2，P < 0.001，图1）。既往腰椎手术史（P = 0.048）、体重指数（BMI）（P = 0.053）和年龄（P = 0.022）与ODI变化相关。近一半（47%）的样本有既往腰椎手术史。有既往腰椎手术史的患者（-7.5，95%可信区间：-8.3，-6.6）的改善程度低于无既往腰椎手术史的患者（-9.1，95%可信区间：-10.9，-7.2，图2）。对于BMI，23%的患者BMI正常，24%的患者超重，53%的患者肥胖。BMI正常的患者（-10.3，95%可信区间：-13.4，-7.2）与超重患者（-7.9，95%可信区间：-9.4，-6.4）和肥胖患者（-7.6，95%可信区间：-9.0，-6.3，图3）相比，改善程度更大。40岁以下的患者（-10.2，95%可信区间：-13.6，-6.8）与40岁及以上的患者（-7.8，95%可信区间：-8.6，-6.8，图4）相比，ODI改善程度更大。
结论
在腰椎管狭窄症患者中，内镜减压术与残疾程度降低相关。无既往腰椎手术史、BMI正常且年龄在40岁以下的患者改善程度更大。
Zotero 插件