Kim Jun-Hoe, Park Hangeul, Lee Chang-Hyun, Kim Chi Heon
Department of Neurosurgery, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Sci Rep. 2025 Jan 29;15(1):3602. doi: 10.1038/s41598-025-88068-3.
Lumbar foraminal stenosis can be surgically treated by foraminal decompression or facet joint resection and fusion (transforaminal lumbar interbody fusion, TLIF). While conventional foraminal decompression poses a risk of segmental instability, the endoscopic approach (extended endoscopic lumbar foraminotomy, EELF) resects only the ventral part of the facet joint with a horizontal surgical trajectory. A prospective observational study was performed to analyze the cost-effectiveness of EELF versus TLIF. Patients with dominant unilateral radicular pain from lumbar foraminal stenosis at or above L4-5, without severe central stenosis or instability, were included from January 2021 to February 2023. EELF involved sufficient foraminal widening using a reamer, followed by an endoscopic procedure. The primary outcome was the cost per quality-adjusted life year (QALY) gain at postoperative 12 months. Among 26 patients in each group, the primary analysis included 23 EELF patients (mean age: 72 ± 8 years) and 22 TLIF patients (mean age: 70 ± 8 years). EELF was significantly more cost-effective (EELF: $15,536.0 ± 4,190.0/QALY vs. TLIF: $32,869.4 ± 5,429.3/QALY, p < .001) and demonstrated shorter operating times, less blood loss, and shorter length of stay (p < .05), with no significant difference in clinical outcomes. Thus, EELF could be a cost-effective and less invasive alternative for treating lumbar foraminal stenosis.
腰椎管狭窄症可通过椎间孔减压或小关节切除融合术（经椎间孔腰椎椎体间融合术，TLIF）进行手术治疗。传统的椎间孔减压存在节段性不稳定的风险，而内镜手术方法（扩大内镜下腰椎椎间孔切开术，EELF）通过水平手术路径仅切除小关节的腹侧部分。本研究进行了一项前瞻性观察性研究，以分析EELF与TLIF的成本效益。纳入2021年1月至2023年2月期间，因L4-5及以上腰椎管狭窄导致单侧神经根性疼痛为主、无严重中央管狭窄或不稳定的患者。EELF包括使用扩孔钻充分扩大椎间孔，随后进行内镜手术。主要结局是术后12个月每获得一个质量调整生命年（QALY）的成本。每组26例患者中，主要分析纳入了23例接受EELF手术的患者（平均年龄：72±8岁）和22例接受TLIF手术的患者（平均年龄：70±8岁）。EELF的成本效益显著更高（EELF：15,536.0±4,190.0美元/QALY vs. TLIF：32,869.4±5,429.3美元/QALY，p<0.001），且手术时间更短、失血量更少、住院时间更短（p<0.05），临床结局无显著差异。因此，EELF可能是治疗腰椎管狭窄症的一种具有成本效益且侵入性较小的替代方法。
