Correlation Between The Clinical Efficacy And Imaging Changes Of Spinal Endoscopy In The Treatment Of Lumbar Posterior Ring Apophysis Fracture

Objective:1.To explore the clinical effect of spinal endoscopy in the treatment of lumbar posterior ring apophysis fracture.2.The correlation between the improvement of clinical symptoms before and after surgery and the imaging changes of the spinal canal was analyzed to provide a theoretical basis for clinical decompression.Methods:A total of 42 patients with posterior ring apophysis fracture of lumbar 4-5 segments who met the inclusion and exclusion criteria from December 2015 to December 2019 were collected.All patients are treated with spinal endoscopy,partial discectomy and complete resection of broken bones under the transforaminal approach endoscope.All patients received visual analogue scale(VAS),Oswestry disability index(ODI),and Japanese Orthopaedic Association(JOA)scores before and after surgery.Perform a modified version of Macnab after surgery;At the same time,preoperative and postoperative imaging examinations were performed to record the changes in data: At the narrowest level of the spinal canal in the 4-5 segment of the lumbar spine,the parameters measured in CT are the spinal canal diameter,the median sagittal diameter of the spinal canal,and the crosssectional area of the spinal canal.The parameters measured in MRI are the median sagittal diameter of the spinal canal,inter-articular diameter,cross-sectional area of spinal canal,cross-sectional area of dural sac,and statistical data analysis.Results:The operation was smooth,with no open transition,dural tear,or nerve root injury.The operation time was 35 to 80 minutes,3 to 17 times of intraoperative fluoroscopy,and the amount of bleeding during the operation was about 10 to 20 ml.Postoperative imaging showed that the dural sac and nerves were completely decompressed and 42 cases of severed bone masses were completely removed.The patient was followed up after surgery,and the excellent and good rate was 95.24% according to the MacNab efficacy evaluation standard.The VAS score obtained at 3 months after surgery decreased from(7.19 ± 0.4)points before surgery to(2.58 ± 0.83)points(P<0.01),and the ODI score decreased from(56.52 ± 3.55)% before surgery to(19.83± 5.0)%(P <0.01),the JOA score increased from(8.48 ± 2.42)points before surgery to(21.71 ± 2.86)points(P <0.01).The differences of spinal canal transverse diameter,spinal canal median sagittal diameter,and spinal canal cross-sectional area in CT before and after surgery,as well as spinal canal median sagittal diameter,interarticular diameter,spinal canal cross-sectional area,and dural sac cross-sectional area in MRI change were analyzed.There was statistical significance(P<0.01).Conclusion:1.Spinal endoscopy can be used to treat posterior ring apophysis fracture of the 4-5 segment of the lumbar vertebrae through a safe and effective minimally invasive approach,which can achieve satisfactory clinical results.2.Improvement of the median sagittal diameter of the spinal canal,the inter-articular diameter,and the cross-sectional area of the spinal canal before and after surgery have a strong correlation with clinical efficacy before and after surgery.The improvement of imaging data can be used as a static method for judging clinical efficacy.At the same time,accurate targeted puncture and thorough nerve decompression are also guarantees of surgical efficacy.