[1]李新锋** 王琨① 靳林煜②.椎间孔镜下神经根腹侧和背侧联合减压治疗高龄退变性腰椎滑脱伴神经根管狭窄症：2年以上随访报告[J].中国微创外科杂志,2020,01(12):1077-1082.
　Li Xinfeng*,Wang Kun,Jin Linyu..Combined Ventral and Dorsal Decompression of Nerve Roots Under Transforaminal Endoscopy for Treatment of Degenerative Lumbar Spondylolisthesis With Foraminal Stenosis in the Elderly[J].Chinese Journal of Minimally Invasive Surgery,2020,01(12):1077-1082.
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椎间孔镜下神经根腹侧和背侧联合减压治疗高龄退变性腰椎滑脱伴神经根管狭窄症：2年以上随访报告()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年12期
页码:
1077-1082
栏目:
临床研究
出版日期:
2020-12-25

文章信息/Info

Title:
Combined Ventral and Dorsal Decompression of Nerve Roots Under Transforaminal Endoscopy for Treatment of Degenerative Lumbar Spondylolisthesis With Foraminal Stenosis in the Elderly
作者:
李新锋** 王琨① 靳林煜②
(上海交通大学医学院附属仁济医院宝山分院骨科，上海200444)
Author(s):
Li Xinfeng*;  Wang Kun;  Jin Linyu.
*Department of Orthopaedics, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200444, China
关键词:
退变性腰椎滑脱; 神经根管狭窄; 椎间孔镜; 减压
Keywords:
Degenerative lumbar spondylolisthesis; Foraminal stenosis; Transforaminal endoscopy; Decompression
文献标志码:
A
摘要:
目的探讨椎间孔镜下部分去除滑脱下方椎体后上缘骨质进行神经根腹侧减压联合背侧减压，治疗高龄退变性腰椎滑脱伴神经根管狭窄症的临床疗效。方法局部下经椎间孔入路，椎间孔镜下去除滑脱下方椎体后上缘骨质进行腹侧减压，同时结合去除部分肥厚黄韧带和增生关节突关节完成神经根背侧减压。采用腿痛视觉疼痛模拟评分(Visual Analogue Scale，VAS)和Oswestry功能障碍指数(Oswestry Disability Index，ODI)评估术后症状改善情况，采用改良MacNab标准进行疗效评估，通过CT和(或)MRI进行术后神经减压的影像学评估，滑脱率评估腰椎滑脱程度。结果术前和术后3个月、术后2年ODI和腿痛VAS评分分别为(6.4±1.2)%、(1.7±1.0)%、(1.7±0.8)%和(68.6±6.7)、(29.6±4.9)、(309±5.0)分，术后均显著改善 (P<0.05)。未出现永久性神经并发症。术后2年改良MacNab标准优良率为85.7%（18/21）。术前和术后2年腰椎滑脱率差异无显著性 ［(18.0±5.1)% vs.(18.5±5.1)%,t=-0.523,P=0.607］。术后CT和(或)MRI显示滑脱椎体下位椎体后上缘向椎管内突出的台阶样压迫被去除，神经根腹侧和背侧减压满意。结论局麻椎间孔镜下部分去除滑脱下方椎体后上缘骨质进行神经根腹侧减压，能减少背侧减压对小关节的破坏，安全可行，为部分腰椎滑脱合并神经根管狭窄症的高龄患者提供一种可供选择的治疗方法。
Abstract:
ObjectiveTo explore the clinical effect of the treatment of ventral combined with dorsal decompression after partial removal of the bone of the posterior upper edge of the vertebral body below the spondylolisthesis for degenerative lumbar spondylolisthesis with foraminal stenosis in the elderly.MethodsIn this study, the elderly patients with degenerative lumbar spondylolisthesis with foraminal stenosis were selected. Under local anesthesia, endoscopic ventral decompression by partially removing posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression by removing the hypertrophic ligamentum flavum and part of the facet joint was performed to complete the decompression of the nerve root. Improvement of clinical outcome was evaluated by the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). The surgical effect was mainly evaluated by the modified MacNab criteria. CT and/or MRI were used to evaluate the neurodecompression. Progression of lumbar spondylolisthesis was compared by measuring the rate of spondylolisthesis. ResultsThe ODI and VAS scores of leg pain before operation, 3 months after operation and 2 years after operation were (6.4±1.2)%, (1.7±1.0)%, (1.7±0.8)%, and (68.6±67), (29.6±4.9) and (30.9±5.0) points, respectively. The ODI and VAS scores of leg pain were significantly improved at 3 months and 2 years followups (P<0.05). There was no permanent neurologic complication. The outcomes of the modified MacNab criteria showed that 85.7%(18/21) of patients obtained goodtoexcellent results at 2 years after operation. There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of followups ［(18.0±5.1)% vs. (18.5±5.1)%,t=-0.523,P=0.607］. After operation, CT and/or MRI showed that the step like compression protruding to the vertebral canal was removed, and the decompression of the ventral and dorsal sides of the nerve root was satisfactory. ConclusionsIt is safe and feasible for endoscopic ventral decompression by partially removing posterosuperior margin underneath the slipping vertebral body under the local anesthesia, which can reduce the damage to the facets during dorsal decompression. It could provide another alternative treatment for some elderly patients with lumbar spondylolisthesis and foraminal stenosis.

参考文献/References:

[1]Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am,2019,30(3):299-304.
[2]Urquhart JC, Alnaghmoosh N, Gurr KR, et al. Posterolateral versus posterior interbody fusion in lumbar degenerative spondylolisthesis. Clin Spine Surg,2018,31(9):E446-E452.
[3]Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med,2016,374(15):1424-1434.
[4]Dijkerman ML, Overdevest GM, Moojen WA, et al. Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review. Eur Spine J,2018,27(7):1629-1643.
[5]Lv Z, Jin L, Wang K, et al. Comparison of effects of PELD and fenestration in the treatment of geriatric lumbar lateral recess stenosis. Clin Interv Aging,2019,14:2187-2194.
[6]Xiong C, Li T, Kang H, et al. Early outcomes of 270degree spinal canal decompression by using TESSYSISEE technique in patients with lumbar spinal stenosis combined with disk herniation. Eur Spine J,2019,28(1):78-86.
[7]Meyerding HW. Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg,1956,26(5 Part 1):566-591.
[8]Macnab I. Negative disc exploration. An analysis of the cause of nerve root involvement in sixty eight patients. J Bone Joint Surg Am,1971,53(5):891-903.
[9]Ravinsky RA, Crawford EJ, Reda LA, et al. Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability. Eur Spine J,2020,29(4):896-903.
[10]Samuel AM, Moore HG, Cunningham ME. Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence. Curr Rev Musculoskelet Med,2017,10(4):521-529.
[11]Mummaneni PV, Bisson EF, Kerezoudis P, et al. Minimally invasive versus open fusion for grade Ⅰ degenerative lumbar spondylolisthesis: analysis of the quality outcomes database. Neurosurg Focus,2017,43(2):E11.
[12]Schller K, Alimi M, Cong GT, et al. Lumbar spinal stenosis associated with degenerative lumbar spondylolisthesis: a systematic review and metaanalysis of secondary fusion rates following open vs minimally invasive decompression. Neurosurgery,2017,80(3):355-367.
[13]李新锋,王琨,靳林煜.脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄.中国微创外科杂志,2020,20(2):151-155.
[14]Strom C, Rasmussen LS, Sieber FE. Should general anaesthesia be avoided in the elderly? Anaesthesia,2014,69(Suppl 1):S35-S44.
[15]徐峰,伍搏宇,席金涛,等.调棒技术与常规穿刺在经皮椎间孔镜腰椎间盘切除术中的比较.中国微创外科杂志,2020,20(4):318-321.
[16]Ahn JS, Lee HJ, Choi DJ, et al. Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy. J Neurosurg Spine,2018,28(5):492-498.
[17]Lee CW, Yoon KJ, Jun JH. Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis. World Neurosurg,2018,113(5):e129-e137.
[18]Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the fullendoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician,2015,18(1):61-70.
[19]Nie H, Zeng J, Song Y, et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: A prospective randomized controlled study with 2year follow up. Spine (Phila Pa 1976),2016,41(Suppl 19):B30-B37.
[20]Mo X, Shen J, Jiang W, et al. Percutaneous endoscopic lumbar discectomy for axillar herniation at L5-S1 via the transforaminal approach versus the interlaminar approach: a prospective clinical trial. World Neurosurg,2019,125(5):e508-e514.

备注/Memo

备注/Memo:
基金项目：上海宝山区科技创新专项资金（医学卫生项目）（19-E-40）**通讯作者，Email:lxfrenji@126.com ①（上海交通大学医学院附属仁济医院脊柱外科，上海200127）②（北京大学人民医院脊柱外科，北京100044）
更新日期/Last Update: 2021-03-03