全内镜下改良椎板间入路治疗融合术后L_(5)-S_(1)椎间孔狭窄的临床疗效及安全性分析

Clinical efficacy and safety of full-endoscopic lumbar decompression at arthrodesis level via a modified interlaminar approach in patients with L_(5)-S_(1) foraminal stenosis

目的评估全内镜下改良椎板间入路治疗融合术后L_(5)-S_(1)椎间孔狭窄的临床疗效及安全性。方法连续收集2015年1月至2018年12月,因腰椎融合术后出现下肢放射痛,经神经根封闭及全内镜下改良椎板间入路手术治疗的11例L_(5)-S_(1)椎间孔狭窄患者的临床资料。于术后第2天复查腰椎MRI及CT评价影像学结果。分别于术后1天、3个月、6个月、1年、2年,采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI)评价临床疗效。于术后2年采用改良MacNab标准对手术临床疗效进行评价。结果11例手术均顺利完成,术中术后无神经根损伤、硬膜撕裂、脑脊液漏、神经功能障碍加重、感染等并发症发生。术后复查腰椎MRI及CT示神经根减压充分。术后各时间点坐骨神经痛VAS评分和术后3个月后腰痛VAS评分及ODI同术前相比较,差异均有统计学意义(P<0.05)。2年随访时,按照改良MacNab标准,优7例,良4例。随访期间所有患者均未接受再次手术。结论全内镜下改良椎板间入路治疗融合术后L_(5)-S_(1)椎间孔狭窄安全、有效。

Objective To evaluate the clinical efficacy and safety of full-endoscopic lumbar decompression (FELD) at arthrodesis level via a modified interlaminar approach in patients with L_(5)-S_(1) foraminal stenosis after posterior instrumented lumbar fusion (PILF).Methods Eleven consecutive patients with sciatica pain after PILF underwent selective nerve root block and then FELD via a modified interlaminar approach.Completeness of decompression was documented with magnetic resonance imaging (MRI) and computer topography (CT) on the second postoperative day.The clinical outcome was evaluated with visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) on the 1st day,3 months,6 months,1 year and 2 years after operation.And the MacNab score were evaluated at 2 years follow-up.Results All operations were successfully completed.There were no intraoperative or perioperative complications,such as nerve injury,dural tear,cerebrospinal fluid leakage,exacerbation of nerve root function injury,or infection.Postoperative reexamination of lumbar MRI and CT in all patients showed adequate nerve root decompression.Postoperative VAS of leg pain at each time point,VAS of low back pain and ODI 3 months postoperatively were significantly improved compared with those preoperatively (P < 0.05).At the 2 years follow-up,7 patients had excellent results and 4 patients had good results according to the MacNab criteria.No patients required further revision surgery.Conclusions FELD via a modified interlaminar approach is effective for the treatment of L_(5)-S_(1) foraminal stenosis after PILF.