| Objective1.To evaluate the safety and effectiveness of percutaneous full-endoscopic lumbar foraminoplasty and decompression by using a visualization reamer in the treatment of elderly lumbar spinal stenosis.2.To evaluate the clinical effect of moxibustion as a postoperative treatment for the patients with low back and leg pain after percutaneous full-endoscopic lumbar foraminoplasty and decompression.MethodsIn the first part,the study tracked 65 elderly patients with lumbar spinal stenosis who were treated with percutaneous full-endoscopic lumbar foraminoplasty and decompression by using a visualization reamer from January 2017 to September 2017 in department of orthopedics,Guangdong Province Hospital of Traditional Chinese Medicine.Clinical data obtained were Oswestry disability index(ODI)and visual analog scale(VAS)for back and leg pain,the improved Macnab standard.Though the collected data,the efficiency of the surgery was analyzed.In the second part,40 selected patients among 65 patients who were still with low back pain after surgery in September 2019 were randomly divided into two groups,control group and moxibustion treatment group.They were followed up for 3 months,and the data was recorded at the time of two weeks,one month and three months.The clinical efficacy-related indicators were recorded,such as VAS for back pain and ODI.SPSS 18.0 was used to analyze the data in different time periods within the group and the same time period between groups.The results were drawn according to the statistical difference.Results1.The average time of follow-up is 16.12 months(range from 12 to 20 months).The average operation time was 98.59 minutes(range from 55 to 120 minutes).The average fluoroscopy frequency was 3.21 times(range from 2 to 6 times).The average postoperative hospital stay was 2.18 days(range from 1 to 4 days).The VAS score of back pain of elderly patients with lumbar spinal stenosis treated by endoscope improved from(3.57±0.97)preoperational to(1.12±0.84)at the last follow-up(P<0.01);the VAS score of leg pain was 7.09±0.88 preoperational compared to the last follow 1.31±0.77(P<0·01);ODI score improved from the preoperative 72.86±6.03 to the last followed 16.11±8.54(P<0.01).Among the modified MacNab criteria,47 cases(72.31%)were excellent,11 cases(16.92%)were good,3 cases(4.62%)were fair,and 4 cases were poor(6.15%).Therefore,excellent or good results were obtained in 89.23%of patients.Two patients suffered from lumbar disc herniation in three months and four months after operation,so they need to be re-operated in PELD.Two patients suffered from lumbar stenosis with lumbar instability and they both performed lumbar fusion at the 12th and 13th months postoperative.In the study,there were no neurological deficits,dura tear,infection or hematoma.2.By random grouping,there was no statistically difference in age,gender,and low back pain VAS score and ODI score before treatment(P>0.05).The two groups were balanced at baseline and comparable.The VAS of the observation group before treatment was(2.75±0.55),the ODI was(20.20±2.89)%;the 2-week treatment of low back pain VAS was(1.55±0.51),and the ODI was(14.60±2.43)%,there was statistically difference between time(P<0.05);1 month treatment of low back pain VAS was(1.45±0.51)points,ODI was(14.102.47)%,significantly lower than before treatment(P<0.05);3 month treatment of low back pain VAS was(1.25±0.44)points,ODI was(10.40±1.54)%,there was statistical difference(P<0.05).In the control group,the low back pain VAS was(2.65±0.49)points,the ODI was(20.10±1.77)%;the two-week treatment low back pain VAS was(2.35±0.49)points,and the ODI was(19.00±2.00)%,the difference was not statistically significant(P>0.05);1 month treatment of low back pain VAS was(2.25±0.44)points,ODI was(18.50±2.33)%,lower than before treatment,the difference was statistically significant(P<0.05);3 months The low back pain VAS was(1.85±0.59)points,and the ODI was(12.60±1.95)%,which was significantly lower than before treatment(P<0.05).Compared between the two groups at 2 weeks,1 month and 3 months after treatment,the VAS and ODI of the observation group were better than the control group,and the difference was statistically significant(P<0.05).ConclusionPercutaneous full-endoscopic lumbar foraminoplasty and decompression by using a visualization reamer is a minimally invasive surgical method with less trauma,less bleeding loss and short hospital stay.It’s worthy for promoting based on the strict indications for surgery.For those who still have low back pain after minimally invasive surgery,moxibustion therapy can effectively reduce postoperative symptoms and promote recovery of patients.The clinical efficacy may be related to reducing edema of lumbar tissue. |
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