| ObjectiveIn this study,short-term follow-up was carried out in patients with lumbar spinal stenosis treated by percutaneous endoscopic interlaminar decompression.By analyzing the radiographic changes and clinical effects,the effectiveness and safety of the operation was evaluated.MethodsFrom January 2017 to may 2018,26 patients with lumbar spinal stenosis who hospitalized in spine surgery in our hospital and received the posterior total spinal endoscopy operation treatment were analyzed retrospectively.The sample consisted of 14 male patients and 12 female patients;the age was 39-82 years old,the average age was 60.50±12.29)years old,and the course of disease was 8-48 months.The clinical effect was evaluated by comparing the visual analogue scale(VAS),Oswestry disability index(ODI)and modified macnab score before and after operation.The lumbar flexion-extension position X-ray was used to measure the intervertebral angle and sliding distance of the operative segment and the upper adjacent segment to evaluate the stability of the spine before and after the operation.Magnetic resonance imaging(MRI)was used to measure the intervertebral space height index(IHI),cross-sectional area of the spinal canal(CASC),and average standard disc signal(CDS)of the operative and upper adjacent segments.ResultsAll patients successfully received the operation,26 patients with a total of 26 segments decompression:L5/S111 cases(42.3%),L4/l513cases(50%),L3/l42 cases(7.7%),one patient suffered from dural sac tear leading to cerebrospinal fluid leakage,one patient suffered from lumbar and lower extremity pain on the second day after the operation,all patients suffered from intestinal perforation,nerve root cauda equina injury,vascular injury and intervertebral disc injury The incidence of complications was 7.7%.The average operation time was 90.77±16.92min,the course of disease was 17.85±10.93 months,the average hospitalization time was 11days(average11±4.46 days),the postoperative follow-up time was 3-29 months(average 15.65±6.25m).The visual analogue score(VAS)of low back pain declined from 7.46±0.76 before operation to 3.42±0.64(P<0.05)on the first day after operation and 1.85±0.73(P<0.05)on the last follow-up.The VAS score of lower extremity pain was decreased from 7.27±0.78 before operation to3.96±0.66(P<0.05)one day after operation and 1.65±0.69(P<0.05)in the last follow-up.The ODI score decreased from 77.79±4.56 before operation to 45.43±4.55(P<0.05)one day after operation and 8.76±2.89(P<0.05)at the last follow-up.According to the modified MacNab score,13 cases were excellent(50.0%),11 cases were good(42.3%),2cases were fair(7.7%),0 case was poor(0%),and the excellent and good rate was 92.3%.There was no significant difference in IHI between the preoperative36.32±6.37%and the last follow-up 34.99±5.45%(P>0.05).Adjacent segment(the previous segment of the operative segment):the change of the IHI from 43.01±6.97%to 34.78±6.07%at the last follw up(P>0.05),the difference was not statistically significant.The value of CASC increased from 116.36±44.89mm~2 before operation to 177.13±61.02mm~2 after operation(P<0.05),and to 183.17±64.57mm~2 at the last follow-up(P<0.05).Adjacent segment(the previous segment of the operative segment):the change of the CASC value from130.25±40.46mm~2 before operation to 133.97±40.51mm~2 after operation(P>0.05),the difference was not statistically significant.At the last follow-up,the change was 133.78±39.60mm~2(P>0.05),the difference was not statistically significant.Before CDS,it was91.98±40.62%,after CDS,it was104.28±45.76%.In the last follow-up,it was 94.90±26.16%.There was no significant difference(P<0.05)..CDS was 93.90±30.32%before operation,108.42±46.01%(P>0.05)after operation,and 108.21±48.12%at the last follow-up(P>0.05),the difference was not statistically significant.The angle of flexion and extension was 8.68±1.39°before operation,6.79±1.82°in the last follow-up(P>0.05),1.40±0.53mm before operation,and 1.12±0.66mm in the last follow-up(P>0.05),No spinal instability was found in these cases.ConclusionIn the short-term follow-up of percutaneous endoscopic interlaminar decompression for lumbar spinal stenosis,it was found that the operation has good clinical effect and sufficient decompression for spinal canal,which will not accelerate the degeneration of intervertebral disc and destroy the stability of lumbar spine. |
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