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INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.
INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.
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Pilot Projects , Patients , Spinal StenosisABSTRACT
Objective:To evaluate the prevalence and distribution of ossification of ligamentum flavum (OLF) at the segments adjacent to the apex in patients with degenerative kyphosis.Methods:All of 74 patients with degenerative kyphosis from January 2018 to December 2021 were retrospective reviewed. All patients were taken anteroposterior and lateral radiographs, CT scan and magnetic resonance imaging (MRI) of the entire spine. Global kyphosis, the morphology of kyphosis and the occurrence of OLF at three segments adjacent to the kyphosis apex were recorded.Results:Of the 74 patients, 54 patients (73%) developed OLF in three segments adjacent to the kyphotic apex. The mean age of the 54 patients was 61.4±6.8 years, and the mean global kyphosis was 49.5°±21.2°. Among other 20 patients without OLF, the mean age was 56.1±7.5 years, and the mean kyphosis angle was 52.1°±19.1°. There was a statistically significant difference in ages ( t=2.92, P=0.005), but no statistically significant difference was observed regarding global kyphosis ( t=0.48, P=0.634). In these 74 patients, 9 patients had angular kyphosis, of which 8 (89%) developed OLF; of the 65 patients without angular kyphosis, 46 patients (71%) developed OLF. There was no significant difference between them (χ 2=1.32, P=0.251). Among the 54 patients diagnosed with OLF, 5 patients (9%) suffered ossification of the posterior longitudinal ligament (OPLL) and 20 patients (37%) suffered dural ossification; 43 patients (80%) developed OLF at proximal segments of apex, 6 patient (11%) developed OLF at distal segments of apex, and 5 patients (9%) developed OLF both at proximal and distal segments of apex. Thirty-two patients (59%) developed OLF at the first segment adjacent to the kyphotic apex, 27 patients (50%) developed OLF at the second segment, and 15 patients (28%) developed OLF at the third segment. Conclusion:Among patients with degenerative kyphosis, about 73% may development OLF within three segments adjacent to the kyphotic apex, and it mostly occurred within two segments adjacent to the apex proximally.
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Objective:To compare the clinical efficacy of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) for unilateral laminotomy for bilateral decompression (ULBD) in the treatment of lumbar spinal stenosis.Methods:Data of 82 patients with lumbar spinal stenosis treated by ULBD under UBE or UE from January 2020 to June 2021 in Dalian Central Hospital affiliated to Dalian Medical University and the First Hospital affiliated to Wenzhou Medical University were retrospectively analyzed, including 36 males and 46 females, aged 63.3±7.5 years (range, 47-81 years). According to the surgical procedure, they were divided into UBE group (42 cases), including 20 males and 22 females; aged 63.2±7.6 years (range, 47-81 years) and UE group (40 cases), including 16 males and 24 females; aged 63.5±7.5 years (range, 48-80 years). Operation time, hospital stay and surgical complications were compared between the two groups. Visual analogue scale (VAS) of low back and leg pain before surgery, 1 day, 7 d, 1 month and 6 months after surgery, and Oswestry disability index (ODI) before surgery, 1 month and 6 months after surgery were compared. Dural sac area before and after surgery, resection angle of ipsilateral facet joint, decompression rate of disc space and bone lateral recess were calculated.Results:All patients were operated successfully. In the UBE group, the operation time was 63.1±7.0 min, and the hospital stay was 3.9±0.9 d. The UE group was 61.2±6.2 min and 3.7±0.9 d, respectively ( t=1.31, P=0.195; t=1.24, P=0.217). The VAS of back and legs pain in UBE group decreased from 7.19±0.97 before operation to 3.43±0.63 points at postoperative 1 day, 1.71±0.60 at postoperative 7 d, 1.33±0.48 at postoperative 1 month and 1.36±0.48 points at postoperative 6 months ( F=352.29, P<0.001). The VAS score of the UE group decreased from 6.85±0.89 points before operation to 2.45±0.75 points at postoperative 1 day, 1.75±0.59 points at postoperative 7 d, 1.33±0.47 points at postoperative 1 month and 1.28±0.45 points at postoperative 6 months ( F=291.44, P<0.001). The VAS of low back and leg pain was higher in the UBE group than in the UE group at 1 day postoperatively ( t=6.41, P<0.001), and the difference was not statistically significant at 7 d postoperatively ( t=-0.27, P=0.786). The ODI of UBE group decreased from 66.62%±4.98% before operation to 21.81%±2.61% at postoperative 1 month and 11.62%±2.31% at postoperative 6 months ( F=1991.35, P<0.001). The ODI score of UE group decreased from 64.35%±5.16% before operation to 22.85%±3.26% at postoperative 1 month and 11.15%±2.86% at postoperative 6 months ( F=1931.18, P<0.001). The postoperative dural sac area of the UBE and UE groups was 135.1±10.0 mm 2 and 120.9±10.4 mm 2 ( t=6.30, P<0.001). The resection angle of ipsilateral facet joint was 69.3°±4.9° and 94.3°±4.1° in the two groups, respectively, with a statistically significant difference ( t=-25.00, P<0.001). The decompression rate of ipsilateral disk-flavum space was 39.0%±3.0% and 38.7%±3.3% in the two groups ( t=1.52, P=0.314). On the contralateral side was 41.6%±3.3% and 22.8%±3.2% ( t=26.32, P<0.001), respectively. The ipsilateral osseous side fossa decompression rate in the two groups were 70.0%±4.8% and 59.3%±3.9% ( t=15.64, P<0.001), the contralateral were 73.0%±3.4% and 48.4%±4.3% ( t=28.86, P<0.001). There was no significant difference in the decompression rate of ipsilateral disco-flavum space or bony lateral recess between the UBE group and the contralateral group ( t=-1.40, P=0.174; t=-1.72, P=0.096), while the decompression rate of discoflavum space and bony side recess on the ipsilateral side of UE group were higher than those on the contralateral side ( t=28.51, P<0.001; t=13.95, P<0.001). Conclusion:Both UE-ULBD and UBE-ULBD have good short-term clinical efficacy in patients with lumbar spinal stenosis. UB is better than UBE in early postoperative pain relief. However, UBE shows better imaging performance in decompression effect and better retention of facet joints.
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Objective:To study the correlation between the quartering of nerve root subsidence sign (NRS) and the cross-sectional area (CSA) of the narrow segment thecal sac in patients with lumbar spinal stenosis (LSS).Methods:The data of 203 LSS patients in the Fourth People′s Hospital of Hengshui from January 2020 to December 2021 were retrospectively analyzed. All patients underwent MRI cross sectional scanning. The patients were divided into positive type a group ( n=62), positive type b group ( n=32), positive type c group ( n=51), and negative group ( n=58) by NRS quartering method. The minimum CSA, median sagittal diameter (PAD), and lateral recess sagittal diameter of each group were compared. The correlation between NRS quartering classification and the minimum CSA and related indicators of lumbar spinal stenosis was analyzed. Results:The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive a group, positive b group, and positive c group were all smaller than those in the negative group, while the Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) were higher than those in the negative group; The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive b type and positive c type groups were smaller than those in the positive a type group, while the VAS score and ODI index were higher than those in the positive a type group; The minimum CSA, PAD, and sagittal diameter of the lateral recess in the positive c type group were smaller than those in the positive b type group; The VAS score and ODI index were higher than those of the positive b type group; The differences were statistically significant (all P<0.05). 203 patients were divided into 54 normal cases, 58 mild stenosis cases, 49 moderate stenosis cases, and 42 severe stenosis cases based on the minimum CSA. The coincidence rate between negative NRS and minimal CSA diagnosis as normal was 94.44%(51/54), the coincidence rate between positive type a and minimal CSA diagnosis as mild stenosis was 84.48%(49/58), the coincidence rate between positive type b and minimal CSA diagnosis as moderate stenosis was 53.06%(26/49), and the coincidence rate between positive type c and minimal CSA diagnosis as severe stenosis was 90.48%(38/42). Using the kappa consistency test, the kappa value for quantitative diagnosis of minimum CSA stenosis in NRS and LSS patients was 0.743, indicating good consistency. The kappa values for quantitative diagnosis of NRS, sagittal diameter of lateral recess, and PAD stenosis were 0.271 and 0.335, with poor consistency. NRS typing was negatively correlated with CSA and PAD ( r=-0.723, -0.581, all P<0.001), and positively correlated with VAS score and ODI index ( r=0.473, 0.640, all P<0.001). Conclusions:The NRS quartering method has a good consistency in diagnosing the severity of LSS patients and the minimum CSA of stenosis segments, suggesting that the NRS quartering method can better reflect the degree of Spinal stenosis, which can not only be used as an auxiliary indicator for qualitative diagnosis of LSS, but also has a high value in quantitative diagnosis.
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Objective:To investigate the optimal cut-off values for the prediction of lumbar spinal stenosis using lumbar pedicle thickness.Methods:The clinical data of 64 patients with lumbar spinal stenosis (patient group) admitted to Binzhou Center Hospital from November 2019 to April 2021 and 48 healthy volunteers (healthy control group) who concurrently received routine physical examination involving lumbar spine MRI examination in the same hospital were retrospectively analyzed. Lumbar pedicle thickness was measured on T 2 weighted images of the L 5 vertebral body in the axial projection. Lumbar pedicle thickness was compared between groups using the independent sample t-test. The relationship between lumbar pedicle thickness and age change was analyzed using a one-way analysis of variance. The efficacy of lumbar pedicle thickness in the diagnosis of lumbar spinal stenosis was evaluated using the receiver operating characteristic (ROC) curve, optimal cut-off values, sensitivity, specificity, and the area under the ROC curve. Results:There was no significant correlation between lumbar pedicle thickness and age change ( P > 0.05). Lumbar pedicle thickness of patients with lumbar spinal stenosis was significantly higher than that of healthy controls [(13.25 ± 1.73) mm vs. (8.54 ± 1.88) mm, t = 13.75, P < 0.05]. ROC curve results showed that the optimal cut-off value was 10.50 mm, with a sensitivity of 95.3% and a specificity of 85.4. The area under the ROC curve was 0.963 (95% CI 0.928-0.998). Conclusion:The increase in lumbar pedicle thickness is related to the increase in the incidence of lumbar spinal stenosis. Lumbar pedicle thickness is an accurate, objective, and clear morphological parameter for the prediction of lumbar spinal stenosis. Application of lumbar pedicle thickness to predict lumbar spinal stenosis is innovative and scientific.
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OBJECTIVE@#To compare the clinical efficacy of full endoscopic lamina fenestration discectomy (Endo-LOVE) with full endoscopic transforaminal approach discectomy in the treatment of degenerative lumbar lateral recess stenosis.@*METHODS@#A retrospective analysis of 48 patients with degenerative lumbar lateral recess stenosis between March 2018 and March 2019 was performed. There were 32 males and 16 females, aged from 60 to 83 years old with an average of (72.9±6.5) years, course of disease ranged from 5 to 16 years with an average of (8.0±2.8) years. The patients were divided into observation group and control group according to surgical approaches. There were 28 cases in observation group, underwent Endo-LOVE surgery;and 20 cases in control group, underwent full endoscopic foraminal approach discectomy. The operation time, intraoperative blood loss, hospitalization day and complications were observed between two groups. Visual analgue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Disability Index(ODI), lateral crypt angle were compared between two groups. And clinical effects were evaluated by modified Macnab standard.@*RESULTS@#There was no significant difference in follow-up and operation time between two groups (P>0.05). Intraoperative blood loss was from 5 to 15 ml with an average of (8.4±3.6) ml in observation group and 5 to 25 ml with an average of (11.5±5.4) ml in control group. The hospitalization day was from 5 to 8 days with an average of (6.0±1.0) days in observation group and 6 to 9 days with an average (7.2±1.1) days in control group. Intraoperative blood loss and hospitalization day were significantly lower in observation group(P<0.05). There were no serious complications in both groups. The VAS, JOA scores, and ODI at 3-month and final follow-up were significantly improved in both groups (P<0.05), and observation group was significantly better than control group (P<0.05). The skeletal lateral crypt angle and soft lateral crypt angle were significantly greater than the preoperative angle at 3 days postoperatively(P<0.05), and observation group was significantly better than control group(P<0.05). At the final follow-up, the modified Macnab criteria was used to assess clinical efficacy, in observation group, 22 patients obtained excellent results, 5 good and 1 fair;while 11 excellent, 4 good and 5 fair in control group;the clinical efficacy of observation group was significantly better than that of control group(P<0.05).@*CONCLUSION@#Both surgical methods are performed under direct vision, with high safety and good clinical efficacy. However, Endo-LOVE enlarged the lateral crypt more fully.
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Male , Female , Humans , Child, Preschool , Child , Adolescent , Retrospective Studies , Blood Loss, Surgical , Constriction, Pathologic/surgery , Lumbar Vertebrae/surgery , Endoscopy/methods , Diskectomy/methods , Treatment Outcome , Spinal Stenosis/surgery , Intervertebral Disc Displacement/surgery , Diskectomy, Percutaneous/methodsABSTRACT
OBJECTIVE@#To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.@*METHODS@#The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females, aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females, aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time, intraoperative blood loss, postoperative drainage volume, and complications were recorded for both groups. Radiologic data including disc height (DH), the left psoas major muscle, multifidus muscle, longissimus muscle area, T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.@*RESULTS@#There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly, the area of the left multifidus muscle and longissimus muscle, as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group, were lower than those in the TLIF group (P<0.05) .On the 1st day and the 5th day after operation, CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation, the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months, low back and leg pain VAS at 3, 6, 12 months between the two groups(P>0.05). In the OLIF group, 1 case of left lower extremity skin temperature increased after the operation, and the sympathetic chain was considered to be injured during the operation, and 2 cases of left thigh anterior numbness occurred, which was considered to be related to psoas major muscle stretch, resulting in a complication rate of 10% (3/30). In the TLIF group, one patient had limited ankle dorsiflexion, which was related to nerve root traction, two patients had cerebrospinal fluid leakage, and the dural sac was torn during the operation, and one patient had incision fat liquefaction, which was related to paraspinal muscle dissection injury, resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6- month follow-up.@*CONCLUSION@#Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However, OLIF surgery has obviously advantages, including less intraoperative blood loss, less postoperative pain, and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle, multifidus muscle, longissimus muscle area, and high signal intensity of T2 image on imaging, it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
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Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Spinal Stenosis/surgery , Blood Loss, Surgical , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment Outcome , Pain, Postoperative , Muscles , Minimally Invasive Surgical Procedures/methodsABSTRACT
OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
Subject(s)
Humans , Decompression, Surgical/methods , Endoscopy/methods , Laminectomy/methods , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Stenosis/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS).@*METHODS@#The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L 2, 3 and L 3, 4 in 2 cases, L 3, 4 and L 4, 5 in 29 cases, L 4, 5 and L 5, S 1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated.@*RESULTS@#All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%.@*CONCLUSION@#UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.
Subject(s)
Male , Female , Humans , Middle Aged , Laminectomy , Spinal Stenosis/surgery , Constriction, Pathologic/surgery , Low Back Pain , Retrospective Studies , Blood Loss, Surgical , Endoscopy , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Decompression, Surgical , Surgical Wound/surgery , Treatment OutcomeABSTRACT
ABSTRACT: Objective: To correlate the four quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS), and EQ-5D in patients who have not received surgical treatment of lumbar stenosis. Methods: Prospective cross-sectional study. Forty patients diagnosed with lumbar stenosis at a university hospital answered four quality-of-life questionnaires in a preoperative consultation. The scores of each questionnaire were tabulated and then compared. In statistical analysis, the Spearman correlation was performed. Results: 17 female and 23 male patients with a mean age of 56.5 years. ODI had an average dysfunction of 44.9%; the PCS score averaged 29.9, and the MCS score of 41.3. The general symptoms of SSS presented a mean of 3.2, and the EQ-5D presented an average of 0.491. The EQ-5D presented the best correlation with the other questionnaires. The score that presented a worse correlation with the other questionnaires was the neuroischemic symptomatology of SSS. Conclusion: quality-of-life questionnaires can be correlated; thus, the evaluation of preoperative patients can be simplified. Level of Evidence III; Diagnostic Studies.
RESUMO: Objetivo: Correlacionar os quatro questionários de qualidade de vida: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) e EQ-5D em pacientes que não foram submetidos a tratamento cirúrgico de estenose lombar. Métodos: Estudo transversal prospectivo. Quarenta pacientes com diagnóstico de estenose lombar acompanhados em hospital universitário responderam a quatro questionários de qualidade de vida em consulta pré-operatória. As pontuações de cada questionário foram tabuladas e depois comparadas. Na análise estatística, foi realizada a correlação de Spearman. Resultados: 17 pacientes do sexo feminino e 23 do sexo masculino com idade média de 56,5 anos. ODI teve uma disfunção média de 44,9%, a pontuação do PCS foi em média de 29,9 e a pontuação do MCS de 41,3. Os sintomas gerais de SSS apresentaram média de 3,2 e o EQ-5D apresentou média de 0,491. O EQ-5D apresentou a melhor correlação com os demais questionários. A pontuação que apresentou pior correlação com os demais questionários foi a sintomatologia neuroisquêmica do SSS. Conclusão: os questionários de qualidade de vida podem ser correlacionados e, assim, simplificar a avaliação dos pacientes no pré-operatório. Nível de Evidência III; Estudo diagnóstico.
RESUMEN: Objetivo: Correlacionar los cuatro cuestionarios de calidad de vida: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) y EQ-5D en pacientes que no han sido sometidos a tratamiento quirúrgico de estenosis lumbar. Métodos: Estudio transversal prospectivo. Cuarenta pacientes con diagnóstico de estenosis lumbar acompañados en un hospital universitario respondieron cuatro cuestionarios de calidad de vida en una consulta preoperatoria. Las puntuaciones de cada cuestionario fueron tabuladas y luego comparadas. En el análisis estadístico se realizó la correlación de Spearman. Resultados: 17 pacientes del sexo femenino y 23 del sexo masculino con una edad media de 56,5 años. ODI tuvo una disfunción promedio de 44,9%, el puntaje PCS promedió 29,9 y el puntaje MCS de 41,3. Los síntomas generales de SSS presentaron una media de 3,2 y el EQ-5D presentó una media de 0,491. El EQ-5D presentó la mejor correlación con los demás cuestionarios. La puntuación que presentó una peor correlación con los demás cuestionarios fue la sintomatología neuroisquémica del SSS. Conclusión: los cuestionarios de calidad de vida se pueden correlacionar y, por lo tanto, se puede simplificar la evaluación de los pacientes preoperatorios. Nivel de Evidencia III; Estudios de diagnósticos.
Subject(s)
Humans , Male , Female , Middle Aged , Orthopedics , Low Back PainABSTRACT
ABSTRACT Objective: The spinous process separation technique is a less invasive surgical technique for treating lumbar canal stenosis. The objective is to evaluate this technique's results in treating lumbar canal stenosis. Method: Thirty patients with lumbar spinal canal stenosis underwent surgical treatment using the spinous process separation technique and were evaluated in the 3-year postoperative period using the Denis Pain and Work Scale and by the SF-36 questionnaire and radiographic evaluation of the operated segment. Results: In the evaluation of the Denis pain scale, 21 (70%) patients had no pain (P1), and nine (30%) patients reported minimal low back pain, not needing medication (P2). Denis' work schedule showed that nine (30%) patients had restrictions on returning to their previous work activity (W2), and 21 (70%) patients were classified as W1. The SF-36 questionnaire showed results of 81.25 for physical aspects (PA), 81.9 for functional capacity (FC), 81.3 for emotional aspects (EA), 64.3 for vitality (V), 65.9 for mental health (MH), 81.98 for social aspects (SA), 75.6 for pain (P) and 68.1 for general health status (GHS). In addition, there were no radiographic signs of instability of the operated vertebral segment in the radiographic evaluation. Conclusion: The decompression of the lumbar spinal canal using the spinous process separation technique showed good results in the evaluated patients three years after the operation. Level of Evidence II, Retrospective Comparative Study.
Resumo: Objetivo: A técnica de separação do processo espinhoso é uma técnica cirúrgica menos invasiva para o tratamento da estenose do canal lombar. O objetivo é avaliar os resultados dessa técnica no tratamento da estenose do canal lombar. Método: Trinta pacientes portadores de estenose do canal vertebral lombar foram submetidos ao tratamento cirúrgico por meio da técnica da separação do processo espinhoso, tendo sido avaliados no período de três anos de pós-operatório, por meio da escala de dor e de trabalho de Denis, pelo questionário SF-36 e avaliação radiográfica do segmento operado. Resultados: Na avaliação da escala de dor de Denis, 21 (70%) pacientes não apresentavam dor (P1) e nove (30%) pacientes relataram dor mínima lombar, não necessitando medicação (P2). A escala de trabalho de Denis evidenciou que nove (30%) pacientes apresentavam restrições ao retorno à atividade prévia de trabalho (W2) e 21 (70%) pacientes foram classificados como W1. O questionário SF-36 apresentou resultados 81,25 para aspectos físicos (AF), 81,9 para capacidade funcional (CF), 81,3 para aspectos emocionais (AE), 64,3 para vitalidade(V), 65,9 para saúde mental (SM), 81,98 para aspectos sociais (AS), 75,6 para dor (D) e 68,1 para estado geral de saúde (EGS). Não foram observados sinais radiográficos de instabilidade do segmento vertebral operado na avaliação radiográfica. Conclusão: A descompressão do canal vertebral lombar por meio da técnica de separação do processo espinhoso apresentou bons resultados na avaliação num período de três anos de pós-operatório dos pacientes avaliados. Nível de Evidência II, Estudo Retrospectivo Comparativo.
Resumen: Objetivo: La técnica de separación de la apófisis espinosa es una técnica quirúrgica menos invasiva para el tratamiento de la estenosis del canal lumbar. El objetivo es evaluar los resultados de esta técnica en el tratamiento de la estenosis del canal lumbar. Método: Treinta pacientes con estenosis del conducto raquídeo lumbar fueron intervenidos quirúrgicamente mediante la técnica de separación de la apófisis espinosa, y fueron evaluados en el postoperatorio de tres años mediante la Escala de Dolor y Trabajo de Denis, mediante el cuestionario SF-36 y evaluación radiográfica del segmento operado. Resultados: En la evaluación de la escala de dolor de Denis, 21 (70%) pacientes no presentaron dolor (P1) y nueve (30%) pacientes refirieron dolor lumbar mínimo, sin necesidad de medicación (P2). La escala de trabajo de Denis mostró que nueve (30%) pacientes tenían restricciones para regresar a su actividad laboral anterior (W2) y 21 (70%) pacientes fueron clasificados como W1. El cuestionario SF-36 arrojó resultados 81,25 para aspectos físicos (AF), 81,9 para capacidad funcional (CF), 81,3 para aspectos emocionales (AE), 64,3 para vitalidad (V), 65,9 para salud mental (SM), 81,98 para aspectos sociales (AS), 75,6 para dolor (D) y 68,1 para estado general de salud (EGS). No hubo signos radiográficos de inestabilidad del segmento vertebral intervenido en la evaluación radiográfica. Conclusión: La descompresión del canal espinal lumbar mediante la técnica de separación de apófisis espinosa mostró buenos resultados en la evaluación de un período de 3 años después de la operación de los pacientes evaluados.
Subject(s)
Humans , Spinal Stenosis , Manipulation, Spinal , Spine , Low Back PainABSTRACT
Achondroplasia (ACH) is a rare autosomal-dominant genetic disease resulting from a mutation in the fibroblast growth factor receptor-3 (FGFR3) gene. It is characterized by asymmetric short stature. Spinal stenosis and thoracolumbar kyphosis (TLK) are common findings in ACH patients. Severe TLK can exacerbate spinal stenosis, leading to neurological complications. This paper provides a brief review of the pathophysiological mechanisms, clinical characteristics, and treatments for spinal stenosis and TLK in ACH patients. Recently, three new drugs targeting FGFR3; vosoritide, recifercept, and infigratinib, have completed or are undergoing clinical trials. They have shown promising preliminary results in preventing spinal stenosis and TLK.
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Objective:To investigate the clinical outcomes of minimally invasive lateral lumbar interbody fusion (LLIF) and the necessity to perform LLIF plus posterior direct decompression in the treatment of severe degenerative lumbar spinal stenosis (DLSS).Methods:In this prospective randomized, controlled trial, we assigned 71 patients, who were 50 to 80 years old, and diagnosed with severe DLSS (Schizas Classification grade C on magnetic resonance imaging), in a 1∶1 ratio to undergo either one-stage LLIF plus posterior internal fixation (treatment group) or CLIF plus posterior internal fixation with laminectomy (control group). Demographic and perioperative data were collected and compared. The clinical outcome measures included Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) score as well as visual analogue scale (VAS). Patients were followed up for at least 1 year.Results:The treatment group included 36 patients with 46 surgical levels, while the control group included 35 patients with 46 surgical levels. The baseline demographic data of the 2 groups were equivalent in preoperative central canal areas, spinal canal anteroposterior diameter, disc height, ODI, ZCQ score for symptom severity and physical function, as well as VAS scores for back and leg pain. The mean operative time, blood loss, drainage volume and hospital stay of the treatment group are significantly less than the control group (157.2±29.1 min vs. 180.6±26.8 min, 75.6±39.1 ml vs. 108.6±43.3 ml, 136.9±73.9 ml vs. 220.5±121.3 ml, 5.3±1.1 d vs. 6.6±2.3 d). There were 2 cases with dura tear and 1 case with wound infection in control group. Thus, the surgical trauma and complications of the control group were more than the treatment group. At 1-year follow-up, the mean ODI score of treatment group improved from 42.24%±10.70% preoperatively to 18.21%±11.49%, the mean ZCQ symptom severity from 2.89±0.38 to 1.61±0.41, the mean ZCQ physical function from 2.31±0.45 to 1.50±0.37, the mean VAS for back from 5.56±1.19 to 1.97±1.13 and the mean VAS for leg from 4.44±1.81 to 0.94±1.26. At 1-year follow-up, the mean ODI score of the control group improved from 43.65%±14.93% preoperatively to 17.36%±12.15%, the mean ZCQ symptom severity from 2.92±0.52 to 1.65±0.39, the mean ZCQ physical function from 2.37±0.52 to 1.55±0.39, the mean VAS for back from 5.63±1.40 to 2.34±1.47, and the mean VAS for leg from 4.37±2.14 to 0.83±1.20. The ZCQ satisfactory score of both groups were not significant different (1.25±0.45 vs. 1.26±0.43, t=0.07, P=0.944). The mean improvement rate of both groups for ODI, ZCQ symptom severity, ZCQ physical function, VAS back and VAS leg at 1-year follow-up were not significant different (55.43%±27.74% vs. 58.36%±25.06%, 43.07%±17.22% vs. 42.66%±12.95%, 32.25%±23.65% vs. 31.71%±23.24%, 62.65%±21.25% vs. 58.37%±22.44%, 78.94%±26.41% vs. 85.45%±20.53%). One adjacent segment disease was found in each group at 1 year follow-up. Conclusion:CLIF+ posterior internal fixation in the treatment of Schizas Grade C DLSS has satisfactory clinical outcome at 1-year follow-up. Laminectomy increases surgical trauma, but does not significantly improve the clinical outcome at 1-year follow-up.
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Objective:To investigate the efficacy of oblique lumbar interbody fusion (OLIF) combined with percutaneous transforaminal endoscopic decompression (PTED) and posterior pedicle fixation through Wiltse approach in the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis.Methods:From June 2017 to February 2022, 103 patients (50 males and 53 females) of lumbar spondylolisthesis accompanied with lumbar spinal stenosis were performed with OLIF combined with PTED and posterior pedicle fixation. The mean age was 64.1±5.2 years (range, 42-87 years). All involved cases were single-segment and included 83 cases of L 4, 5, 17 cases of L 3, 4, and 3 cases of L 2, 3. Among them, 94 cases were performed for the first time, and other 9 were revision surgery treated by posterior lumbar laminectomy previously. The visual analog scale (VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index (ODI) was used to evaluate the lumbar function. The VAS and ODI scores were recorded respectively before the operation, at discharge, 1, 3, 6 months after the operation and at the last follow-up. Macnab criteria was used to evaluate the clinical efficacy at the last follow-up. At the same time, imaging measurements were conducted, including the anterior and posterior disc height, segmental lordotic angle, percentage of slip on lateral X-ray film and the vertebral canal area on axial MRI before and after surgery. Results:All of 103 patients were successfully operated in one stage with an average operation time of 177.7±21.5 min (range, 155-220 min), and an average intraoperative blood loss of 55.9±18.3 ml (range, 30-150 ml). The mean follow-up time were 15.1±2.6 months (range, 6-36 months). There were significant differences in both VAS scores of back and leg and ODI scores at each postoperative time point when compared with preoperative ( F=508.25, F=1524.82, F=1148.68, P<0.001). Macnab criteria of the last follow-up was evaluated as follow: excellent in 85 cases, good in 14, fair in 4, and the excellent and good rate was 96.1%. The radiographic results showed the mean immediate postoperative anterior disc height, posterior disc height, segmental lordotic angle, percentage of slip and axial area of the vertebral canal were 15.23±2.97 mm, 9.32±2.31 mm, 14.36°±4.18°, 3.89%±3.11%, 113.37±47.27 mm 2, and thus all of those increased significantly compared to the mean preoperative 11.93±3.17 mm, 7.21±2.03 mm, 6.15°±3.99°, 23.66%±7.79%, 57.63±28.91 mm 2, respectively ( t=7.84, t=7.07, t=14.91, t=27.62, t=9.68, P<0.001). All cases achieved bony fusion during 6-12 months after operation. The incidence of surgery-related complications was 10.7% (11/103). There were 3 cases of end plate fracture and 2 cases of dural injury, which had no complaint after operation. There was 1 case of pedicle screw entering into the spinal canal by mistake, and the symptoms of nerve damage appeared after operation. After 1 year it basically returned to normal. There were 2 cases of thigh numbness and 1 case of psoas major weakness after operation, all of which relieved after 4 weeks. There was 1 case continuous pain of abdominal incision after surgery. There was 1 case of cage subsidence at the last follow-up. Conclusion:OLIF combined with PTED and posterior pedicle fixation through Wiltse approach is a minimally invasive surgical method for the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis. With the combined minimally invasive techniques, the decompression, fusion and fixation of the lumbar spine can be fulfilled perfectly. It has the advantages of minimally invasive, good clical outcome, few complications and rapid rehabilitation.
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INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.
INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.
Subject(s)
Spinal Stenosis , Patients , WalkingABSTRACT
Objective:To investigate the influence of different degrees of facet joint arthropathy on the indirect decompression effect of crenel lumbar interbody fusion (CLIF), and the clinical outcomes of CLIF for the treatment of lumbar spinal stenosis with severe facet joint arthropathy (grade 3).Methods:This study reviewed a total of 269 surgical segments in 156 patients with lumbar spinal stenosis treated with CLIF technique from November 2016 to February 2020. According to preoperative CT images, the facet joint was graded according to Pathria classification. There are 19 segments with grade 0, 156 segments with grade 1, 67 segments with grade 2, and 27 segments with grade 3. Radiographic parameters included disc angle, anterior and posterior disc height, and bilateral intervertebral foramen height on CT, and the midsagittal canal diameter and axial central canal area. In 30 patients with at least one segment of grade 3, the clinical efficacy was assessed using visual analogue scale (VAS) and Oswestry disability index (ODI).Results:The average the anterior and posterior intervertebral space height, intervertebral space angle, height of bilateral intervertebral foramina, spinal canal sagittal diameter and spinal canal area were significantly improved after the operation of grade 3 facet joint degeneration segment compared to preoperation. The preoperative mean spinal canal sagittal diameter and spinal canal area of grade 3 facet joint degeneration segment were significantly less than grade 1 and grade 2. The average change of spinal canal area after grade 3 articular degeneration was significantly less than that of grade 1 and 2, but there was no significant difference with that of grade 0. The posterior decompression rate was 55.56% (15/27) for grade 3, 35.82% (24/67) for grade 2, 16.03% (25/156) for grade 1, and 21.05% (4/19) for grade 0. The posterior decompression rate of grade 3 articular process degeneration was significantly higher than that of other grades ( P<0.001). Severe lateral recess stenosis and 24.24% of severe intervertebral foraminal stenosis were found in 81.48% of grade 3 degenerative segment. The 23 patients were followed up with an average of 21.62±6.52 months, and the average improvement of ODI was 24.10%±11.09%; the average VAS for leg pain and back pain were improved significantly. Conclusion:The degrees of facet joint degeneration do not prevent intervertebral space distraction of CLIF. However, because segments with severe facet joint arthropathy were usually associated with severe spinal canal stenosis, CLIF had a high rate of second-stage posterior decompression in the treatment of lumbar spinal stenosis with severe facet joint arthropathy.
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Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.
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Objective:To analyze the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the Zista channel assisted by navigation for the treatment of lumbar spinal stenosis.Methods:The medical records of 156 patients who underwent surgery for lumbar spinal stenosis from January 2017 to January 2019 were retrospectively analyzed. The patients were divided into minimally invasive group, navigation open group and open group according to surgical method and navigation usage. 67 cases were treated with MIS-TLIF assisted by navigation in minimally invasive group. In the navigation open group, 31 cases underwent open TLIF surgery assisted by navigation, 58 cases were treated with open TLIF. The database was compared among the three groups including intraoperative blood loss, operative time, postoperative drainage, postoperative hospitalization time and complications. Evaluated the internal fixation and fusion according to CT, assessed the surgical results according to VAS, ODI and SF-36. The clinical effects were evaluated by MacNab scores at the last follow-up.Results:The amount of intraoperative blood loss in the minimally invasive group 116.39±25.88 ml was less than that in the navigation open group 293.94±61.67 ml and the open group 396.97±92.58 ml, and the difference was statistically significant ( F=296.01, P<0.001). The intraoperative blood loss in the navigation open group was less than that in the open group. The postoperative drainage in the minimally invasive group 80.55±27.29 ml, was less than that in the navigation open group 299.94±50.32 ml and the open group 304.86±84.34 ml, and the difference was statistically significant ( F=273.14, P<0.001). The postoperative hospitalization time in the minimally invasive group 3.42±1.00 d was less than that in the navigation open group 7.16±1.39 d and the open group 7.31±1.69 d, and the difference was statistically significant ( F=154.49, P<0.001). There was no significant difference in the operation time ( F=0.15, P=0.859). At 2 weeks and 3 months after operation, the VAS score of low back pain in the open navigation group (3.84±0.82, 1.90±0.91) and the open group (3.67±0.92, 1.91±0.90) and ODI in the navigation open group (34.74%±11.66%, 28.68%±8.19%) and the open group (32.21%±10.66%, 27.17%±9.59%) were lower than those in the minimally invasive group (1.70±0.92, 0.96±0.73), (18.33%±7.43%, 19.15%±7.96%), and the difference were statistically significant [( F=96.63, P<0.001; F=25.12, P<0.001), ( F=45.59, P<0.001; F=18.99, P<0.001)]. The SF-36 score of the minimally invasive group 61.48±9.50 at the last follow-up was higher than that of the navigation open group 52.51±6.99 and the open group 53.48±7.66, and the difference was statistically significant ( F=18.97, P<0.001). In the same group, the VAS score, ODI score and SF-36 score at each follow-up time after surgery were statistical differences compared with those before surgery ( P<0.05). Postoperative follow-up CT showed that the fusion rate of the minimally invasive group was 94.0% (63/67), the navigation open group was 93.5% (29/31), the open group was 93.1% (54/58), and the difference between the three groups was not statistically significant (χ 2=0.05, P=0.978). The success rate and accuracy of one-time nail placement in the minimally invasive group and the navigation open group were higher than those in the open group, the difference was statistically significant (χ 2=17.17, P<0.001; χ 2=15.49, P=0.040). Dural rupture occurred in 1 patient in the minimally invasive group and 2 patients in the open group. The drainage and condition changes were closely observed after surgery. All patients were successfully extubated after surgery without complaining of other discomfort. One patient in the minimally invasive group had endplate destruction and mild intervertebral collapse during postoperative follow-up. There was 1 case of incisional fat liquefaction in each of the navigation open group and the open group. Subgroup analysis of the results of the three groups were roughly the same as the overall results. Conclusion:MIS-TLIF in the Zista channel assisted by navigation is a safe, effective, and worthy of promotion minimally invasive lumbar fusion surgery with the advantages of less trauma and faster recovery in the treatment of different types of lumbar spinal stenosis.
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Objective:To compare the efficacy and safety of unilateral biportal endoscopy (UBE) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis by Meta-analysis.Methods:PubMed, Web of Science, CNKI and Wanfang Data were searched from their establishment to January 2021 for all the studies on UBE and MED in the treatment of lumbar spinal stenosis. The data extracted were authors, year of publication, study design, subject characteristics, sample size, surgical protocol, age, sex ratio, duration of surgery, length of hospital stay, complications, visual analogue scale (VAS), and Oswestry Disability Index (ODI). The Meta-analysis was conducted with software Revman 5.3 to analyze the operation time, hospital stay, complication rate, waist and lower extremity VAS scores and ODI scores at preoperation, early postoperation and the last follow-up. The quality of the case-control studies included was evaluated using the Newcastle Ottawa Scale (NOS) while the methodological quality and risk of bias of the randomized controlled studies (RCT) included were evaluated using the Cochrane Bias Risk Assessment Tool.Results:Finally, 7 studies were included, 6 in English and one in Chinese. There were 2 RCTs and 5 case-control studies. There were 251 patients in the UBE group and 224 patients in the MED group. Compared with the MED group, the UBE group had a significantly shorter hospital stay ( MD=-2.28, 95% CI: -3.42 to -1.14, P<0.001), and a significantly lower VAS score for early postoperative low back pain ( MD=-0.80, 95% CI:-1.44 to -0.16, P=0.01). There were no significant differences between the 2 groups in operation time, complication rate, waist VAS scores at preoperation or the last follow-up, lower extremity VAS or ODI scores at preoperation, early postoperation or the last follow-up, or dural dilatation area ( P>0.05). Conclusions:In the treatment of lumbar spinal stenosis, compared with MED, UBE is superior in early relief of low back pain and hospital stay after operation, but shows no significant difference in long-term efficacy or safety.
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Objective:To investigate the safety and efficacy of the modified transcutaneous endoscopic spine system (TESSYS) with full visual foramen plasty and percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:A case-control study was conducted to analyze the clinical data of 68 patients with single segment lumbar disc herniation and lumbar spinal stenosis treated with visual endoscopic foraminal plasty and modified TESSYS technique and intervertebral foraminal fusion from April 2020 to March 2021. According to the operation method, 38 cases were divided into two groups: pted group (38 cases) and TLIF group (30 cases). Independent sample t-test was used to compare the incision length, bleeding volume, operation time, time to go down and hospital stay between the two groups. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were measured repeatedly. The differences between preoperative and postoperative 7 days and 1, 3, 6 months were analyzed and compared by generalized estimation equation. Rank sum test was performed in combination with the modified MacNab standard in the last follow-up. The excellent and good rate was compared between groups χ 2. Test and evaluate the curative effect. Results:The postoperative follow-up was 8.5-14.0 months. The incision length (1.25±0.33) cm, operation time (119.45±14.95), blood loss (24.03±8.62) mL, downtime time (1.42±0.50) d, and hospital stay (3.39±0.55) d in the PTED group were all higher than those in the TLIF group ((14.37±2.91) cm, (140.53±16.16) min, (158.00±51.35) mL, (3.20±0.96) d, (7.33±0.55) d) had obvious advantages ( t values were 24.56, 5.57, 14.13, 9.20, and 29.48, respectively; all P<0.001). The VAS scores and ODI scores of the two groups after operation were significantly improved compared with those before operation (all P<0.001), and with the passage of time, the VAS scores and ODI scores of the two groups of patients from 7 days to 6 months after operation by month were significantly decreased ( P<0.001). However, there was no significant difference between the two groups in VAS score from 1 week to 6 months after operation: P7d=0.997, P1 month=0.139, P3 month=0.057, P6 month=0.539, all P>0.05. There was no significant difference in ODI scores between time points (ODI: P7d=0.278, P1 month=0.442, P3 month=0.963, P6 month=0.278, all P>0.05). There was no significant difference between the two groups in terms of clinical efficacy and excellent and good rate evaluated by modified MacNab criteria at the last follow-up ( Z=0.09, P=0.927; χ 2=0.92, P=0.761). Conclusion:The short-term curative effect of full visual endoscopic foraminal plasty and modified TESSYS technique in the treatment of single level lumbar disc herniation and lumbar spinal stenosis is close to that of classical foraminal interbody fusion, and has certain advantages.