腰椎管狭窄症内镜减压影像与临床资料的相关性

Correlation between imaging and clinical data in endoscopic decompression for lumbar spinal stenosis

摘要:

[目的]探讨腰椎管狭窄症（lumbar spinal stenosis, LSS）内镜减压影像与临床资料的相关性。[方法]2020 年 1 月—2022 年 8 月本院对 76 例 LSS 患者行经皮经椎间孔内镜减压术。末次随访时按改良 Macnab 评价临床疗效将患者分组，比较患者临床与影像资料，分析末次随访影像参数与 VAS 评分、ODI 指数的相关性。[结果]按 Macnab 标准，末次随访时临床结果评定为优 36 例，良 32 例，可 8 例，此三组患者的 VAS 评分 [(1.3±0.2) vs (1.7±0.4) vs (2.6±0.8), P＜0.001]、ODI 指数 [(20.9±4.3)% vs (25.5±5.3)% vs (32.4± 3.4)%, P＜0.001]、中央椎管横断面积 [(169.3±18.3) mm² vs (164.5±15.8) mm² vs (156.4±13.4) mm² , P＜0.001]、侧隐窝前后径 [(5.3±0.7) mm vs (4.9±0.6) mm vs (4.2±0.4 ) mm, P＜0.001]、椎间孔矢状面积 [(90.2±9.0) mm² vs (86.4±8.1) mm² vs (80.5±6.8) mm² , P＜0.001]、硬膜囊横断面积 [(138.5±10.3) mm² vs (134.4±9.2) mm² vs (126.3±8.6) mm² , P＜0.001]和硬膜囊最大矢状径 [(21.7±4.0) mm vs (19.6±3.3) mm vs (17.9±2.8) mm, P＜0.001] 的差异均有统计学意义。相关分析表明：VAS 评分与中央椎管横断面积（r=-0.429, P＜0.001），侧隐窝前后径 （r=-0.346, P＜0.001），椎间孔矢状面积 （r=-0.354, P＜0.001），硬膜囊横断面积 （r=-0.216, P=0.023） 和硬膜囊最大矢状径 （r=-0.254, P=0.014）均呈显著负相关；ODI 评分与中央椎管横断面积（r=-0.420, P＜0.001）、侧隐窝前后径（r=-0.335, P＜0.001）、 椎间孔矢状面积（r=-0.373, P＜0.001）、硬膜囊横断面积（r=-0.213, P=0.022）和硬膜囊最大矢状径（r=-0.252, P=0.013）均呈显著负相关。[结论]LSS 经皮经椎间孔脊柱内镜治疗后 CT、MRI 影像测量参数与临床疼痛、功能障碍评分具有显著关联。

Abstract:

[Objective] To investigate the correlation between imaging and clinical data in endoscopic decompression for lumbar spinal stenosis (LSS). [Methods] From January 2020 to August 2022, 76 patients with LSS underwent percutaneous transforaminal endoscopic decompression in our hospital. At the last follow-up, patients were grouped according to the clinical efficacy evaluated by modified Macnab criteria. The clinical and imaging data of patients were compared, and the correlation between the imaging parameters and VAS score or ODI score was analyzed. [Results] According to Macnab criteria, 36 cases were excellent, 32 cases were good, and 8 cases were fair at the last follow-up. There were significantly differences in terms of VAS score [(1.3±0.2) vs (1.7±0.4) vs (2.6±0.8), P＜0.001], ODI score [(20.9±4.3)% vs (25.5±5.3)% vs (32.4±3.4)%, P＜0.001], as well as the radiographic measurements including central canal crosssectional area (CCCSA) [(169.3±18.3) mm² vs (164.5±15.8) mm² vs (156.4±13.4) mm² , P＜0.001], lateral recess anteroposterior diameter (LRAPD) [(5.3±0.7) mm vs (4.9±0.6) mm vs (4.2±0.4) mm, P＜0.001], sagittal area of the intervertebral foramen (SAIF) [(90.2±9.0) mm² vs (86.4±8.1) mm² vs (80.5±6.8) mm² , P＜0.001], dural sac cross-sectional area (DSCSA) [(138.5±10.3) mm² vs (134.4±9.2) mm² vs (126.3±8.6) mm² , P＜0.001] and the dural sac maximum sagittal diameter (DSMSD) [(21.7±4.0) mm vs (19.6±3.3) mm vs (17.9±2.8) mm, P＜0.001]. As results of correlation analysis, the VAS score was significantly negatively correlated with CCCSA (r=-0.429, P＜0.001), LRAPD (r=-0.346, P＜0.001), SAIF (r=-0.354, P＜ 0.001), DSCSA (r=-0.216, P=0.023) and DSMSD (r=-0.254, P=0.014). Similarly, the ODI score proved significantly negatively correlated with CCCSA (r=-0.420, P＜0.001), LRAPD (r=-0.335, P＜0.001), SAIF (r=-0.373, P＜0.001), DSCSA (r=-0.213, P=0.022) and DSMSD (r=-0.252, P=0.013). [Conclusion] After percutaneous transforaminal endoscopic decompression for LSS, the measured parameters of CT and MRI images are significantly correlated with clinical pain and dysfunction scores.