| Objective:The purpose of this study is to explore the safety and efficacy of using PELD(Percutaneous endoscopic lumbar discectomy,PELD)to correct Lenke-Silva level-I adult degenerative scoliosis;In this study,we explore whether PELD can provide a new option for patients of adult degenerative scoliosis or not,as a individuational and stepped-care approach.Methods:In this study,the clinical and image data of PELD Lenke-Silva I degenerative scoliosis patients in the Department of orthopedics of Kunming Yan'an Hospital from September 2016 to March 2018 were collected by questionnaire,and the quality of life of EQ-5D and SRS-30 was evaluated by a prospective study method.In the study,preoperative and postoperative VAS score,operation time,operative blood loss and intraoperative X-ray fluoroscopy were collected and recorded.The patients' ODI,EQ-5D and SRS-30 scores were followed up after operation.The data were expressed in(x±s).The follow-up data of 6 months after the operation were compared with the data before the operation,and the statistical data were compared with the paired sample t test,and the difference of P<0.05 was statistically significant.At the last follow-up,the clinical efficacy was evaluated by the modified MacNab criteria.Results:In this study,21 cases were collected and followed up,including 9 males and 12 females,with a mean age of 47-80 years(60.7±9.6)and an average of Cobb angle 11.2 to 21.6°average(14.9±2.5)°.The distribution data of the lesions were as follows:1 cases of L1/2,2 cases of L3/4,10 cases of L4/5 and 8 cases of L5/S1.The main manifestations were the main leg pain,low back pain,13 cases of nerve root pain and 8 cases of intermittent claudicating.The duration of follow-up was 6-18 months,with an average of(11.3±4.0)months.The operation time was 90-130 minutes,average(107.6±12.2)minutes,intraoperative fluoroscopy 10-20 times,average fluoroscopy(15.3±2.7)times,intraoperative bleeding volume 6-10ml,average bleeding volume(8.4±1.7)ml.After excluding 1 woman,PELD was performed on the patient.After a week,the MIS-TILF recurred to the left lower extremity due to recurrent radicular symptoms.Second days after surgery,5 patients felt the hips with different degrees of pain,pain relief treatment,treatment after treatment,the symptoms remission,the rest of the patients had no special complications.In the study,none of the following complications occurred:infection of incisional wound,injury of nerve and sheath,rupture of dural sac.Data statistics showed that the VAS score of low back pain(t=2.96,P<0.05)was 6 months after surgery,and the difference was statistically significant.Compared with the follow-up of 6 months after operation,the VAS score of anterior leg pain was statistically significant(t=13.54,P<0.05).The ODI score(t=14.38,P<0.05)was significantly different between the two groups before and 6 months after operation,and the difference was statistically significant.The EQ-5D index(t=15.53,P<0.05)was followed up 6 months after operation,and the difference was statistically significant.The EQ-VAS score(t=13.23,P<0.05)was 6 months after surgery and the difference was statistically significant.After the operation in June and before the operation,the SRS-30 scale score(P<0.05)in function/activety dimension,pain dimension,self image/appearance dimension and mental health dimension(P<0.05),the difference was statistically significant,and the quality of life of the patients after treatment was improved.The curative effect evaluation criteria of modified Macnab were excellent in 7 cases(33.3%),good in 11 cases(52.4%),fair in 2 cases(9.5%),poor in 1 cases(4.8%),and the excellent and good rate was 85.7%.Conclusion(s):For the treatment of Lenke-Sivla I degenerative scoliosis,PELD therapy has the advantages of small soft tissue injury,less bleeding in the operation,quick recovery after operation,and high satisfaction after treatment.The short-term effect is satisfactory and safe and effective.This treatment can provide a new option for individualized and stepped treatment of degenerative scoliosis patients.The results of the present study do not prove that this approach provides a theory for standardized staircase degenerative scoliosis patients;to achieve this goal,long-term follow-up,multicentre research,and evidence-based medical evidence support are needed. |
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