椎弓根上隐窝在经皮内镜下经椎间孔入路腰椎侧隐窝减压术中的意义

Significance of suprapedicular foraminal in percutaneous full-endoscopic transforaminal lumbar lateral recess decompression

背景:行侧隐窝减压术以缓解神经根性症状是退行性腰椎管狭窄症治疗的关键,已有文献报道经皮椎间孔入路内镜技术是腰椎侧隐窝狭窄症患者安全、有效、微创的手术方法。目的:总结经皮内镜下经椎间孔入路腰椎侧隐窝减压术治疗腰椎管狭窄症的疗效,并探讨椎弓根上隐窝结构的内镜下显露和减压技术。方法:选择2014年3月至2017年6月间31例主要表现为侧方椎管狭窄的腰椎管狭窄症患者,均采用经皮内镜下经椎间孔入路行腰椎侧隐窝减压术。记录术前、术后及末次随访时腰痛、坐骨神经痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),并进行比较,同时采用改良MacNab标准对手术疗效进行评估。结果:所有患者术后随访9～18个月,平均随访(12.4±2.9)个月。术后末评分均较术前降低[(1.8±0.6)分vs(4.4±1.1)分,(1.2±0.7)分vs(5.4±1.1)分,(18.6±4.3)分vs(47.2±7.6)分],且差异均有统计学差异(t=9.57、16.96、18.02,P均<0.01)。按照改良MacNab评分标准评估手术疗效:优15例,良13例,可2例,差1例,优良率为90.3%(28/31)。结论:经皮内镜下经椎间孔入路腰椎侧隐窝减压术治疗以侧方椎管狭窄为主的腰椎管狭窄症可以取得良好疗效,适应证的选择非常重要,应注重腰椎管狭窄的病理学解剖分析,尤其重视椎弓根上隐窝的减压是获得良好临床疗效的关键。

Background: It is essential to relieve symptom of radiculopathy via lumbar lateral recess decompression for thetreatment of degenerative lumbar spinal stenosis. It has been reported that percutaneous transforaminal endoscopic approach issafe, effective and minimally invasive in patients with lumbar lateral recess stenosis. Objective: To summarize the efficacy ofpercutaneous full-endoscopic lumbar lateral recess decompression through transforaminal approach on the treatment of lum-bar spinal stenosis and to discuss the strategy of endoscopic exposure and decompression. Methods: From March 2014 to June 2017, 31 patients with lumbar lateral recess stenosis, who were in accordance with the research criteria, were collected. All pa-tients underwent percutaneous endoscopic transforaminal lumbar lateral recess decompression. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) were recorded preoperatively, postoperatively and at the last follow-up. Thesurgical effectiveness was evaluated according to modified MacNab score. Results: All the patients were followed up for(12.4±2.9) months on average(range, 9-18 months). VAS scores of low back and sciatica and ODI were significantly decreased at thelast follow-up as compared with postoperative ones(1.8±0.6 vs 4.4±1.1, t=9.57;1.2±0.7 vs 5.4±1.1, t=16.96;18.6±4.3 vs 47.2±7.6, t=18.02;P<0.01). Surgical outcome was excellent in 15 cases, good in 13 cases, fair in 2 cases and poor in one. Total ex-cellent and good rate was 90.3%(28/31). Conclusions: Percutaneous endoscopic transforaminal decompression of the lumbarlateral recess provides a safe and effective alternative for treating lumbar lateral recess stenosis. The indications and pathologi-cal anatomy of lumbar spinal stenosis should be taken into consideration. The exposure and decompression of the suprapedicu-lar recess is the key to achieve satisfactory results.