大通道脊柱内镜辅助下腰椎椎间融合术治疗腰椎退行性疾病3年以上随访的疗效观察

Minimum of 3-year follow-up outcomes of lumbar interbody fusion via larger-diameter endoscope for lumbar degenerative diseases

目的分析大通道脊柱内镜辅助下腰椎椎间融合术(镜下融合)治疗腰椎退行性疾病3年以上的随访结果。方法2018年6月至2020年6月中山大学附属第三医院脊柱外科接受镜下融合手术腰椎退行性疾病患者共28例;女20例,男8例;年龄40~80(58.9±10.6)岁。病程为1~240(44.0±53.3)个月。诊断为单纯腰椎椎管狭窄5例、单纯腰椎不稳3例、腰椎椎管狭窄合并不稳5例、腰椎退行滑脱12例、复发型腰椎间盘突出症3例;其中26例为单节段,2例为双节段;12例经椎间孔入路,16例经关节突入路;11例(68.8%)行单侧入路双侧减压。术前、术后及末次随访使用腰椎Oswestry功能障碍指数(ODI)、腰痛及腿痛的视觉模拟评分(VAS)、日本骨科协会评分(JOA)评价疗效。对随访腰椎CT影像按照Bridwell标准判断椎间融合情况。结果所有患者均顺利完成镜下融合手术;手术时间为239~630(399.8±104.4)min。所有病例随访时间为37~61(44.7±6.2)个月。术后及末次随访ODI评分、腰痛及腿痛VAS评分、JOA评分均较术前明显改善(P<0.05)。术后椎间隙高度较术前增加[(12.2±2.1)mm比(8.3±2.8)mm,P<0.05]。术中、术后及随访时均无严重并发症发生,1例患者术后椎管内骨块残留压迫行走根。随访期间14例复查腰椎CT;其中13例(92.9%)达到骨性融合。结论大通道脊柱内镜辅助下腰椎椎间融合术3年以上随访临床疗效令人满意,是治疗腰椎退行性疾病的一种微创、安全、有效的术式选择。

Objective To explore the 3-year follow-up clinical outcomes of endoscopic lumbar interbody fusion with larger-diameter endoscope for the treatment of lumbar degenerative disease.Methods From June 2018 to June 2020,28 patients diagnosed with lumbar degenerative diseases in Department of Spine Surgery,Third Affiliated Hospital of Sun Yat-sen University,were treated with endoscopic lumbar interbody fusion;20 of whom were female and 8 were male.The age was 40-80(58.9±10.6)years old,with symptom duration of 1-240(44.0±53.3)months.There were 5 patients diagnosed with spinal stenosis,3 with lumbar instability,5 with spinal stenosis and instability,12 with lumbar spondylolisthesis,and 3 with recurrent disc herniation;26 of them underwent single-level surgery,while the remaining 2 underwent two-level surgery.The surgical procedure was performed on 12 patients via transforaminal approach;16 patients were performed via trans-facet joint approach;11(68.8%)of them received unilateral laminotomy with bilateral spinal canal decompression.The clinical result was evaluated by Oswestry disability index(ODI),visual analogue scale(VAS)for back pain and leg pain,and Japanese orthopaedic association(JOA)scale before surgery,after surgery and at final follow-up respectively.Interbody bony fusion was assessed by CT imagies during follow-up based on Bridwell criteria.Results All patients underwent endoscopic lumbar interbody fusion without conversion to open surgery.The operation time was 239-630(399.8±104.4)min.During a minimum of 3-year follow-up[follow-up time was 37-61(44.7±6.2)months],the ODI scores,VAS of waist and leg and JOA score was significantly improved postoperatively and at final follow-up(P<0.05).The intervertebral height was significantly increased after surgery[(12.2±2.1)mm vs.(8.3±2.8)mm,P<0.05].No severe complications occurred during follow-up.Residual bony mass was found with nerve compression in 1 case after surgery.At last follow-up 14 case recieved CT examination,and the presence of bony fusion at surgical segment was confirmed in 13 cases(92.9%).Conclusion Endoscopic lumbar interbody fusion with larger-diameter endoscope is a minimally-invasive,safe and effective alternative of the treatment for lumbar degenerative diseases with satisfied minimum 3-year follow-up outcomes.