Indications And Clinical Efficacy Of Spinal Endoscopy In The Treatment Of Lumbar Spinal Stenosis

Object: To evaluate the clinical characteristics,indications and clinical efficacy of spinal endoscopy in the treatment of lumbar spinal stenosis by comparison with the of open surgery.Methods: 30 patients with degenerative lumbar spinal stenosis who underwent endoscopic approach from October 2015 to September 2016 were treated as minimally invasive group,including 13 males and 17 females with an average age of 56.60 ± 7.63.30 patients with open surgery were selected as the control group by age,operative segment and follow-up time as matching factors.including 14 males and 16 females with an average age of 57.13 ± 7.58.The operative time,intraoperative blood loss,bedridden time,hospitalization time,cost and other related indexes were compared between the two groups.The two groups were evaluated by visual analogue scale(VAS)before,1 day,3 months and 6 months after operation,Preoperative,postoperative 1 month,3 months,and 6 months were assessed with the Oswestry disability index(ODI)and the modified Mac Nab criteria were used to assess clinical efficacy.Results: Minimally invasive group :The average age was 56.6 ± 7.63 years,the average operation time was 94.43 ± 14.4 min,the average intraoperative blood loss was 14.00 ± 4.98 ml,the average bedtime was 8.13 ± 0.73 h,the average hospital stay was 3.57 ± 0.57 days,the average hospitalization cost 20573.57 ± 1582.63 yuan,the average follow-up time of 9.70 ± 1.73 months;Open group :The average age of the open group was 57.13 ± 7.58 years,the average operation time was 160.43 ± 12.05 min,the average intraoperative blood loss was 268.67 ± 44.08 ml,the average bedtime was 73.77 ± 5.25 h,the average hospital stay was 7.03 ± 0.81 days,the average hospitalization cost was 37890.50 ± 1044.19 The mean follow-up time was 9.81 ± 54 months.There was no significant difference in sex,age and mean follow-up time between the minimally invasive group and the open group(P> 0.05).The average operative time,mean blood loss,average bedridden time,average hospitalization time and average hospitalization were better than those in open group(P <0.05).All the patients in the two groups were successfully completed in all cases and follow-up according to regulations,followed up for 6 to 13 months.The VAS score and the ODI score were significantly lower in the two groups of patients during the same follow-up period(P <0.05).There was no significant difference in VAS score,VAS score and ODI score between the two groups before surgery(P> 0.05).There were significant differences in VAS score,VAS score and ODI score between the two groups before and after operation(P <0.01).At the last follow-up,Mac Nab was used to evaluate the postoperative curative effect.The excellent and good rate of minimally invasive group was 73.3% and the excellent rate of open group was 90.0%.Conclusion: For patients with lumbar spinal stenosis,endoscopic approach by endoscopic surgery has the advantages of less trauma,shorter operative time,shorter hospitalization time,low cost.Endoscopic technique can obtain satisfactory therapeutic effect with limitations of lumbar spinal canal stenosis caused by lumbar disc herniation,epiphyseal ring disruption and stenosis of various types of intervertebral foramen caused by thickening of ligamentum flavum and cohesion of the articular process.For patients with general anesthesia contraindications,we can try to use endoscopic surgery under local anesthesia.Although spine endoscope technology is developing rapidly,but the application of surgery for spinal stenosis in the difficult,For severe diffuse stenosis of lumbar spinal canal,the effect of endoscopic surgery is not ideal,and the risk of decompression is not complete,and the overall efficacy is not as good as open surgery.