ABSTRACT
【Objective】 To compare the clinical efficacy of percutaneous transforaminal endoscopic decompression （PEID） and percutaneous interlaminar endoscopic decompression （PETD） in the treatment of L5-S1 lateral recess stenosis. 【Methods】 We selected the patients in our center diagnosed with L5-S1 lateral recess stenosis from March 2018 to October 2019 and divided them into Group A and Group B according to the principle of prospective， single-blind， and randomized control （A： PETD； B： PEID）. The operation was performed by the same senior surgeon with mature spinal endoscopy technology. We recorded the basic information， operation duration， usage count of C-arm， hospital stay， VAS score and ODI index of lower back and lower limbs before operation and 3 days， 1 month， 1 year and the last follow-up after the operation， and the operative excellent and good rates （the last follow-up）. The angle of bony lateral recess was measured during pre- and postoperative CT. 【Results】 A total of 95 patients （A： n=48； B： n=47） successfully completed the operation and were followed up for at least 1 year. The two groups did not significantly differ in age， gender， hospital stay， or complication by lumbar intervertebral disc herniation， but PEID group had significantly shorter operation duration and fewer usage counts of C-arm （P<0.001）. VAS score of lower back and lower limbs， and ODI index were significantly reduced at 3 days，1 month， 1 year and the last follow-up after the operation， with no significant difference between the two groups at the same time； no statistical difference was found between the two groups in operative excellent and good rates at the last follow-up （P>0.05）. The postoperative bony side recess angle was significantly improved （P<0.05）， while there was no significant difference in either pre- or postoperative bony side recess angle between the two groups （P>0.05）. 【Conclusion】 Both PEID and PETD are effective strategies in the treatment of L5-S1 lateral recess stenosis and can achieve good clinical outcomes.
ABSTRACT
Objective To explore the application value of self-made directional arcuate bone drill during vertebroplasty by observing its operative effects for osteoporosis in vitro . Methods EDTA-Na2 was used to soak the prepared vituline osteoporotic vertebral bodies in vitro .A total of 40 osteoporotic vertebral bodies were randomly divided into Group A and B , with each group having 20 vertebral bodies for vertebroplasty .The Group A underwent a puncture by routine straight bone drill , while the Group B received a puncture by self-made directional arcuate bone drill with the arc directing toward the contralateral , which terminated when the drill reached the first 1/3 of vertebral body .Finally, statistical analysis was conducted on the distance between the bone drill bit and exterior margin of contralateral vertebral body , as well as whether bone cement reached or went over the vertebral sagittal midline . Results The osteoporotic vertebral bodies were successfully prepared in vitro by using EDTA-Na2 immersion decalcifying for 9 days. In the Group A, the drill bit was (2.50 ±0.32) cm away from contralateral exterior margin of vertebral bodies , which was significantly different from that in the Group B (0.90 ±0.26) cm (t=17.354, P=0.000).The bone cement reached or went over the vertebral sagittal midline in 11 vertebral bodies in the Group A and in 19 vertebral bodies in the Group B , with statistical difference ( Fisher’ s test,P=0.004).The intraspinal bone cement leakage occurred in 9 vertebral bodies in the Group A and 4 in the Group B, without significant difference between the two groups (Fisher’s test,P=0.176). Conclusion The self-made directional arcuate bone drill can build an osseous channel that reach or go over the vertebral sagittal midline and guide bone cement distributed to contralateral puncture , which avoids the disadvantages of bilateral vertebral pedicular puncture .The result shows that the self-made directional arcuate bone drill has more adventages in vertebroplasty than that of traditional straight bone drill but doesn ’ t have significant advantages in preventing bone cement leakage .
