腰椎管狭窄症单侧与双侧通道减压融合比较

Unilateral versus bilateral channel endoscopic decompression in minimal invasive transforaminal lumbar interbody fusion for lumbar spinal stenosis

摘要:

［目的］ 比较单侧与双侧通道减压微创经椎间孔入路腰椎融合术 （minimal invasive transforaminal lumbar interbody fu- sion, MIS-TLIF） 治疗腰椎管狭窄症 （lumbar spinal stenosis, LSS） 的效果。［方法］ 回顾性分析本院 2018 年 1 月—2021 年 6 月采用 MIS-TLIF 治疗的 90 例 LSS 患者的临床资料。依据术前医患沟通结果，47 例采用单侧通道双侧减压，另外 43 例采用双侧通道双侧减压。比较两组围术期情况、随访与影像学资料。［结果］两组均顺利手术，术中无严重并发症。早期并发症发生率单侧组为 10.64%，双侧组为 11.63%，差异无统计学意义 （P=0.881）。单侧组手术时间、术中失血量、术中透视次数、术后下地行走时间均显著优于双侧组（P<0.05），两组间切口总长度、切口愈合等级和住院时间的差异无统计学意义（P>0.05）。两组患者均获随访 12 个月以上，两组恢复完全负重活动时间的差异无统计学意义 （P>0.05）。随时间推移，两组 VAS 和 ODI 评分显著减少 （P<0.05），而 JOA 评分显著增加 （P<0.05）。术前两组间 VAS、ODI 和 JOA 评分的差异均无统计学意义 （P>0.05）， 但是，出院时、术后 6、12 个月单侧组的上述临床评分均显著优于双侧组 （P<0.05）。影像方面，与术前相比，术后即刻和末次随访时两组患者椎间隙高度、最小椎管面积、腰椎前凸角均显著改善 （P<0.05）。相应时间点，两组间在上述指标的差异均无统计学意义 （P>0.05）。相应时间点两组间 Bridled 融合分级的差异均无统计学意义 （P>0.05）。末次随访时两组所有患者均无钉棒松动、断裂、椎间融合器移位等不良影像表现。［结论］MIS-TLIF 单侧与双侧通道减压均可有效治疗 LSS，相比之下单侧通道术中创伤小、术后下床早、康复快，临床效果均优于双侧通道。

Abstract:

[Objective] To compare the clinical outcomes of unilateral versus bilateral channel endoscopic decompression in minimally invasive transforaminal interbody fusion (MIS-TLIF) for lumbar spinal stenosis (LSS) . [Methods] A retrospective study was conducted on a total of 90 patients who received MIS-TLIF for LSS in our department from January 2018 to June 2021. According to preoperative doctorpatient communication, 47 patients underwent bilateral decompression through an unilateral channel, with the remained 43 cases received bilateral decompression through bilateral channels. The perioperative conditions, follow-up and imaging data of the two groups were com- pared. [Results] All patients in both groups were operated on successfully with no serious intraoperative complications. The incidence of early complications was of 10.64% in unilateral group, while 11.63% in bilateral group, which was not statistically significant (P=0.881) . The unilateral group proved significantly superior to the bilateral group in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy times and postoperative walking time (P＜0.05) , although there was no significant difference in total incision length, incision healing grade and hospital stay between the two groups (P＞0.05) . All patients in both groups were followed up for more than 12 months, and there was no statistical significance in the time to resume full weight-bearing activities between the two groups (P＞0.05) . The VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly over time in both groups (P＜0.05) . There were no sig- nificant differences in VAS, ODI and JOA scores between the two groups before surgery (P＞0.05) , however, the unilateral group proved sig- nificantly superior to the bilateral group in abovementioned clinical scores at discharge, 6 months and 12 months after surgery (P＜0.05) . Regarding imaging, the height of the intervertebral space, the minimum spinal canal area, and the lumbar lordosis angle significantly im- proved in both groups immediately after surgery and at the last follow-up compared with preoperative results (P＜0.05) , whereas no statisti-cal significance was found in the above indexes between the two groups at any corresponding time points (P＞0.05) . There was no statistical- ly significant difference in the Bridled fusion grade between two groups at any corresponding time points (P＞0.05) . At the last follow-up, all patients in both groups had no adverse imaging manifestations such as screw loosening, fracture, and interbody fusion cage displace- ment. [Conclusion] Both unilateral and bilateral channel decompression in MIS-TLIF do effectively treat LSS. By comparison, unilateral channel decompression achieve better clinical results than bilateral channel, with less intraoperative trauma, earlier postoperative ambula- tion, and faster recovery.