Zhang Yao, Lin Wancheng, Lian Xin, Ding Lixiang, Song Jipeng
Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian, Beijing, People's Republic of China.
Department of General Surgery, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China.
Global Spine J. 2025 May;15(4):2140-2151. doi: 10.1177/21925682241288189. Epub 2024 Sep 25.
Study DesignA retrospective study.ObjectivesTo investigate and compare the clinical and radiographical outcomes of endoscopic decompression alone and limited decompression/fusion surgery in the treatment of adult degenerative scoliosis (ADS).MethodsFollow-up data of 53 patients with lower limb radiculopathy associated with ADS who underwent focal surgical treatment were collected (endoscope group: 31 patients treated by transforaminal endoscopic decompression alone; fusion group: 22 patients who underwent limited decompression/fusion). The following data were retrospectively analyzed and compared between the two group: the demographics, Lenke-Silva level, radiographic parameters, surgical data, visual analogue scale (VAS) for back/leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria.ResultsThe mean follow-up period was 15.68 ± 3.26 months. The most frequent Lenke-Silva level was I in the endoscope group, and III in the fusion group. Preoperative Cobb angle in the endoscope group was significantly lower than that in the fusion group (23.92 ± 9.06 vs 39.58 ± 13.12, < 0.05). All patients exhibited improved VAS and ODI scores postoperatively ( < 0.05). At the last follow-up, the Cobb angle had progressed by 1.51° in the endoscope group, whereas radiographic parameters were significantly improved in the fusion group. The reoperation and complication rate in the endoscope group were lower than those in the fusion group. The satisfaction rate post-surgery was comparable between the two groups.ConclusionsFor patients with focal ADS, both limited decompression/fusion and transforaminal endoscopic decompression are viable treatment options. Advanced transforaminal endoscopic techniques enable effective decompression of the symptomatic foramen with minimal complication risk and negligible deformity progression, even in cases of significant scoliosis. While limited fusion surgery can achieve comparable clinical outcomes, it offers inferior deformity correction.
研究设计
一项回顾性研究。
目的
探讨并比较单纯内镜减压与有限减压/融合手术治疗成人退变性脊柱侧凸（ADS）的临床和影像学结果。
方法
收集53例因ADS伴下肢神经根病接受局部手术治疗患者的随访数据（内镜组：31例仅接受经椎间孔内镜减压治疗；融合组：22例行有限减压/融合手术）。对两组患者的以下数据进行回顾性分析和比较：人口统计学资料、Lenke-Silva分级、影像学参数、手术数据、腰/腿痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）以及改良MacNab标准。
结果
平均随访时间为15.68±3.26个月。内镜组最常见的Lenke-Silva分级为I级，融合组为III级。内镜组术前Cobb角显著低于融合组（23.92±9.06 vs 39.58±13.12，P<0.05）。所有患者术后VAS和ODI评分均有改善（P<0.05）。末次随访时，内镜组Cobb角进展了1.51°，而融合组影像学参数显著改善。内镜组再次手术率和并发症发生率低于融合组。两组术后满意度相当。
结论
对于局限性ADS患者，有限减压/融合和经椎间孔内镜减压都是可行的治疗选择。先进的经椎间孔内镜技术能够有效减压有症状的椎间孔，并发症风险最小，畸形进展可忽略不计，即使在严重脊柱侧凸病例中也是如此。虽然有限融合手术可获得相当的临床结果，但其畸形矫正效果较差。
