Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
BMC Musculoskelet Disord. 2024 Nov 25;25(1):955. doi: 10.1186/s12891-024-08090-w.
Excellent surgical outcomes of microendoscopic laminectomy (MEL) have been reported for patients with lumbar spinal canal stenosis (LSCS). However, few reports have directly compared MEL with open laminectomy for multi-level LSCS. This study conducted a comparative analysis of patient-reported outcomes (PROs) and perioperative complications in patients undergoing two-level posterior decompression for LSCS by MEL versus open laminectomy.
This multicenter retrospective cohort study involved prospectively registered patients who underwent two-level posterior lumbar decompression surgery for LSCS at one of eight high-volume spine centers between April 2017 and February 2020. Chart sheets were used to prospectively evaluate demographic data, including diagnosis, operative procedure, operation time, estimated blood loss, and perioperative complications. The PROs evaluated were the numerical rating scale (NRS) score for lower back pain and leg pain, 12-item Short Form Health Survey (SF-12) score, EuroQol 5-Dimension (EQ-5D) score, Oswestry Disability Index (ODI) score, and patient satisfaction with the treatment.
Of the 882 patients enrolled, 410 underwent MEL (MEL group) and 472 underwent open decompression (open group). A total of 667 (75.6%) patients completed the 1-year follow-up. Intraoperative blood loss was significantly lower in the MEL group than in the open group. The complication rate was comparable (12.4% in MEL group, 12.5% in open group). Although the revision rate did not differ significantly, the incidence of surgical site infection (SSI) was markedly lower in the MEL group (0.0% in MEL group, 1.3% in open group). Propensity score matching was employed to compare 333 patients who underwent MEL with 333 patients who underwent open laminectomy. Intraoperative blood loss was significantly lower in the matched MEL group than in the matched open group. The incidence of SSI was markedly lower in the matched MEL group (0.0% in matched MEL group, 1.2% in matched open group). No significant differences in the preoperative and postoperative values of the PROs or patient satisfaction were observed between the two groups.
MEL required an equivalent operating time and resulted in less intraoperative blood loss compared with laminectomy in two-level procedures. The incidence of SSI was significantly lower in the MEL group.
经微内窥镜椎板切除术（MEL）治疗腰椎管狭窄症（LSCS）患者的手术效果极佳。然而，鲜有研究直接比较 MEL 与开放性椎板切除术治疗多节段 LSCS 的效果。本研究对 8 家大容量脊柱中心在 2017 年 4 月至 2020 年 2 月期间采用 MEL 或开放性椎板切除术对 2 节段 LSCS 患者进行的 2 级后路减压术进行了患者报告结局（PROs）和围手术期并发症的对比分析。
这是一项多中心回顾性队列研究，前瞻性纳入在 8 家大容量脊柱中心中的 1 家接受 2 节段 LSCS 后路减压手术的患者。使用图表评估患者的人口统计学数据，包括诊断、手术过程、手术时间、估计失血量和围手术期并发症。评估的 PROs 包括下腰痛和腿痛的数字评分量表（NRS）评分、12 项简短健康调查（SF-12）评分、欧洲五维健康量表（EQ-5D）评分、Oswestry 残疾指数（ODI）评分和对治疗的满意度。
在纳入的 882 例患者中，410 例行 MEL（MEL 组），472 例行开放性减压术（开放组）。共有 667 例（75.6%）患者完成了 1 年随访。MEL 组的术中失血量明显低于开放组。并发症发生率相当（MEL 组为 12.4%，开放组为 12.5%）。虽然翻修率无显著差异，但 MEL 组的手术部位感染（SSI）发生率明显较低（MEL 组为 0.0%，开放组为 1.3%）。采用倾向评分匹配比较了 333 例行 MEL 手术的患者和 333 例行开放性椎板切除术的患者。MEL 组的术中失血量明显低于匹配的开放组。在匹配的 MEL 组中，SSI 的发生率明显较低（0.0%在匹配的 MEL 组，1.2%在匹配的开放组）。两组患者的术前和术后 PROs 或对治疗的满意度无显著差异。
与 2 级手术中的椎板切除术相比，MEL 手术时间相当，术中失血量更少。MEL 组 SSI 的发生率显著较低。
