| Objective:To explore the efficacy and safety of unilateral laminotomy for bilateral decompression through interlaminar approach under percutaneous large diameter endoscopy and visual trephine in the treatment of single level central lumbar spinal stenosis,and to compare the two surgical methods,so as to provide a better surgical choice for the treatment of single level lumbar spinal stenosis.Methods:Data of single level central lumbar spinal stenosis admitted to Affiliated Hospital of Yangzhou University from January 2018 to Deccmber 2021 were collected,and 81 cases were enrolled in the study due to the inclusion and exclusion criteria.Among them,5patients were lost to follow-up during the study period,and 3 patients could not provide complete re-visit information.A total of 73 patients completed the study.Thirty-one patients were enrolled in the group of visible trephine assisted transforaminal spinal endoscopy group(trephine group),including 16 women and 15 men,with a mean age of73.19±5.66 years.Forty-two patients were enrolled in the group of percutaneous large diameter endoscopy group(big diameter group),including 19 women and 23 men,with a mean age of 73.10±5.08 years.All patients in both groups received surgical treatment successfully and were followed up for more than 1 year.The operation duration,total length of hospital stay and other data between the two groups were compared.Dural sac cross-sectional area,intervertebral height,lumbar motion,visual analogue scores of pain,Oswestry Disability Index,modified Mac Nab evaluation criteria,complications and other indicators were measured and evaluated before and after operation between the two groups.Results:Patients in both groups were followed up for more than 1 year,and there were no statistical differences in gender,age,course of disease,body mass index,surgical segment,and underlying diseases between the two groups(P>0.05).The operation duration was113.87±17.78 minutes in trephine group and 96.55±11.92 minutes in big diameter group,the operation duration of big diameter group was shorter than of trephine group,the difference was statistically significant(P<0.05).The total length of hospital stay was3.45±0.72 days in trephine group and 3.50±0.74 days in big diameter group,and there was no statistical difference between the two groups(P>0.05).During follow-up,the postoperative dural sac cross-sectional area of both groups was increased compared with that before surgery(P<0.05),and the average dural sac expansion area of the big diameter group was greater than that of the trephine group(P<0.05),there were no significant changes in the height of intervertebral space and lumbar motion between the two groups before and after surgery(P>0.05).The visual analogue scores of waist and leg,Oswestry Disability Indexes of both groups at 1week,3 months and 12 months after surgery were lower than those before surgery(P<0.05),and there was no significant difference between groups at different time nodes(P>0.05).At the 12 months after surgery,the excellent and good rate of modified Mac Nab evaluation criteria was 87.10 % in the trephine group and88.10% in the big diameter group,and there was no statistical difference between the two groups(P>0.05).In addition,one patient in the big diameter group developed intraoperative dural sac tear,and no abnormal situation was observed during follow-up after timely treatment;no intraoperative or postoperative complications occurred in the other patients.Conclusion:The unilateral laminotomy for bilateral decompression through interlaminar approach under percutaneous large diameter endoscopy and visual trephine got the same excellent clinical efficacy in the treatment of single level central lumbar spinal stenosis,but the long-term(more than one year)clinical efficacy still needs further study.The percutaneous large diameter endoscopy has advantages in shortening operation duration,increasing dural sac cross-sectional area,which is worthy of promotion. |
