大通道脊柱内镜下腰椎椎间融合术治疗腰椎滑脱症的疗效与安全性

Efficacy and safety of lumbar interbody fusion with larger-diameter endoscope of spine surgery for spondylolisthesis

目的探讨大通道脊柱内镜下腰椎椎间融合术治疗腰椎滑脱症的疗效与安全性。方法纳入2018年6月至2022年11月中山大学附属第三医院收治的72例单节段大通道镜下融合患者,其中腰椎滑脱症36例(滑脱组),包括退行性Ⅰ°滑脱15例、Ⅱ°滑脱3例,峡部裂性Ⅰ°滑脱11例、Ⅱ°滑脱7例;术前不存在滑脱的腰椎退行性疾病36例(非滑脱组)。采用腰椎Oswestry功能障碍指数(ODI)、腰痛及腿痛视觉模拟量表(VAS)、日本骨科协会(JOA)评分评价临床疗效,通过术后腰椎正侧位X线片及腰椎CT评估椎管减压情况,根据Bridwell标准评估术后随访6个月以上腰椎融合情况。结果平均随访时间(31.0±13.3)个月(8~61个月)。滑脱组手术时间、术中出血量、住院时间与非滑脱组比较,差异无统计学意义(P>0.05)。两组术后及末次随访ODI、腰痛及腿痛VAS评分及JOA评分均较术前改善,手术前后比较,差异具有统计学意义(P<0.05);两组间术后及末次随访时各项评分比较,差异无统计学意义(P>0.05)。滑脱组术后平均椎间隙高度(13.43 mm)高于非滑脱组(12.03 mm),差异有统计学意义(P<0.05);两组融合率相近(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05),且均无严重并发症发生。结论大通道脊柱内镜下腰椎椎间融合术治疗腰椎滑脱症是一种安全有效的选择,但对于L5~S1节段峡部裂性Ⅱ°滑脱,镜下融合操作具有较高的技术挑战性。

Objective To explore the efficacy and safety of lumbar interbody fusion with larger-diameter spinal endoscope for the treatment of lumbar spondylolisthesis.Methods A total of 72 patients who underwent single-level lumbar interbody fusion with larger-diameter endoscope from June 2018 to November 2022 in the Third Affiliated Hospital of Sun Yat-sen University were included.Thirty-six patients with lumbar spondylolisthesis were included in the spondylolisthesis group,including 15 cases of degenerative Grade Ⅰ spondylolisthesis,3 cases of degenerative Grade Ⅱ,11 cases of isthmic Grade Ⅰ,and 7 cases of isthmic Grade Ⅱ spondylolisthesis.The remaining 36 patients with lumbar degenerative diseases without preoperative spondylolisthesis were included in the non-spondylolisthesis group.Clinical outcomes were evaluated by using Oswestry disability index(ODI),visual analogue scale(VAS)for back and leg pain,and Japanese Orthopaedic Association(JOA)scores.All patients underwent postoperative imaging with antero-lateral lumbar X-rays and lumbar CT scans to assess decompression of the spinal canal.Fusion status was evaluated based on Bridwell criteria using CT scans obtained at least 6 months postoperatively.Results The mean follow-up period was(31.0±13.3)months(range 8 to 61 months).There were no significant differences between the spondylolisthesis and non-spondylolisthesis groups in terms of operative time,intraoperative blood loss,or length of hospital stay(P>0.05).Both groups showed improvement in ODI,VAS scores of back pain,and leg pain,and JOA scores at the postoperative and final follow-up assessments compared to preoperative values(P<0.05),with no statistical differences of the above indicators at the postoperation and the latest follow-up when compared between the two groups(P>0.05).The mean postoperative disc height in the spondylolisthesis group(13.43 mm)was higher than that in the non-spondylolisthesis group(12.03 mm),with statistical differences between two groups(P<0.05).Fusion rates in the two groups were similar(P>0.05).No serious postoperative complications was found in either group,and the incidence of complications did not differ significantly between the groups(P>0.05).Conclusions Lumbar interbody fusion with larger-diameter spinal endoscope is a safe and effective alternative for treatment of lumbar spondylolisthesis.However,manipulation at the L5/S1 level for isthmic Grade Ⅱ spondylolisthesis still present a great technical challenge.