全可视脊柱内镜减压治疗腰椎侧隐窝狭窄症

Fullvisual endoscopic decompression for lumbar lateral recess stenosis

摘要:

[目的] 探讨全可视脊柱内镜减压治疗腰椎侧隐窝狭窄症 （lumbar spinal lateral recess stenosis, LLRS） 的临床疗效。 [方法] 回顾性分析 2021 年 6 月—2023 年 6 月本院收治 93 例单节段 LLRS 患者的临床资料，均行全可视脊柱内镜减压治疗。 评价临床与影像资料。[结果]患者均顺利完成手术，术中均未改变手术方式，术中 1 例硬膜囊撕裂，术后 2 例残留腰腿痛，2 例下肢麻木加重。随访 （14.9±2.3） 个月，与术前相比，术后 3 个月及末次随访时腰 VAS 评分显著降低 [(4.7±0.8), (1.8±0.4), (1.1±0.2), P＜0.001]，腿 VAS 评分显著降低 [(5.8±1.2), (1.7±0.5), (1.0±0.2), P＜0.001]，ODI 指数显著降低 [(53.1±6.4), (22.3±3.8), (13.8±2.4), P＜0.001]，椎管面积显著增加 [(1.4±0.4) cm² , (2.1±0.2) cm² , (2.1±0.2) cm² , P＜0.001]，侧隐窝前后径显著增加 [(2.4±0.3) mm, (4.3±0.4) mm, (4.2±0.4) mm, P＜0.001]，末次随访按 MacNab 疗效标准手术优良率为 96.8%。[结论] 全可视脊柱内镜减压治疗 LLRS 能够有效且相对安全地解除侧隐窝神经根受压，缓解腰、腿疼痛症状。

Abstract:

[Objective] To explore the clinical efficacy of full-visual spinal endoscopy decompression in the treatment of lumbar spinal lateral recess stenosis (LLRS). [Methods] A retrospective study was conducted on 93 patients who had single-segment LLRS treated by full-visual spinal endoscopy decompression in our hospital from June 2021 to June 2023. The clinical and imaging data were evaluated. [Results] All patients had operation performed successfully without change of surgical approach. However, one patients suffered from dural sac tear during the operation, 2 presented residual low back and leg pain, and 2 patients got aggravated lower extremity numbness after the operation. With time before operation, 3 months postoperatively and at the latest follow-up lasted for (14.9±2.3) months in a mena, the VAS scores of lumbago [(4.7±0.8) score, (1.8±0.4) score, (1.1±0.2) score, P＜0.001], VAS of leg pain [(5.8±1.2) score, (1.7±0.5) score, (1.0±0.2) score, P＜0.001] and the ODI [(53.1±6.4) score, (22.3±3.8) score, (13.8±2.4) score, P＜0.001] significantly decreased, while the spinal canal area [(1.4±0.4) cm² , (2.1±0.2) cm² , (2.1±0.2) cm² , P＜0.001], and the anteroposterior diameters of the lateral recess [(2.4±0.3) mm, (4.3±0.4) mm, (4.2±0.4) mm, P＜0.001] significantly increased. The excellent and good rate of clinical outcome was of 96.8% at the last follow-up according to the MacNab criteria. [Conclusion] Full-visual spinal endoscopic decompression for LLRS can effectively and relatively safely relieve the nerve root compression in the lateral recess, and alleviate the symptoms of low back and leg pain.