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  • Title: [Effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification].
    Author: Liu Y, Cai P, Kong Q, Song Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Nov 15; 31(11):1326-1333. PubMed ID: 29798586.
    Abstract:
    OBJECTIVE: To investigate the feasibility, effectiveness, and security of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification. METHODS: Between July 2008 and June 2016, 96 patients with lumbar spine disorders (lumbar disc herniation or lumbar spinal stenosis) with intraspinal ossification were treated with percutaneous endoscopic spine surgery. There were 59 males and 37 females, aged from 13 to 57 years (mean, 29.5 years). The disease duration was 3-51 months (mean, 18.2 months). Fifty-one cases had trauma history. Ninety-two cases were single segmental unilateral symptom, 4 cases were bilateral symptom. The ossification property was posterior ring apophysis separation in 89 cases, and ossification of the fibrous ring or posterior longitudinal ligament in 7 cases. There were 32 cases of lateral type, 13 cases of central type, and 51 cases of mixed type. The pressure factors, such as nucleus pulposus, hyperplasia of the yellow ligament, joint capsule, or articular osteophyma, were removed under the microscope. Local anesthesia or continuous epidural anesthesia was performed in the transforaminal approach with 50 cases, and continuous epidural anesthesia or general anesthesia was performed in the interlaminar approach with 46 cases. The visual analogue scale (VAS) score was used to evaluate the degree of leg pain preoperatively and at last follow-up. The effectiveness was evaluated at last follow-up according to the modified Macnab criteria. RESULTS: All patients were successfully operated. Via transforaminal approach, the mean operation time was 53 minutes and the mean intraoperative fluoroscopy times was 8 times; and via interlaminar approach was 58 minutes and 3 times, respectively. The mean bed rest time after operation was 6.5 hours and the mean hospitalization time was 4.7 days. All patients were followed up 6-18 months (median, 11 months). Postoperative lumbar CT scan and three-dimensional reconstruction after 3 days of operation showed that ossification tissues of 26 cases were not resected, 12 cases were resected partly, and 49 cases were resected completely. Postoperative lumbar MRI after 3 months of operation showed that spinal cord and nerve root were not compressed. At last follow-up, VAS score of leg pain was 0.7±1.1, which was significantly lower than preoperative score (5.8±1.1) ( t=1.987, P=0.025). At last follow-up, according to modified Macnab criteria, the results were excellent in 87 cases, good in 5 cases, and fair in 4 cases, and the excellent and good rate was 95.8%. CONCLUSION: Percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification is an effective, safe, and minimal invasive alternative, and the short-term effectiveness is reliable. Accounting for the treatment of intraspinal ossification, comprehensive analysis should be made by combining clinical symptoms, imaging characteristics, and risk assessment. 目的: 探讨经皮全脊柱内窥镜技术治疗合并椎管内骨化腰椎疾患的可行性﹑有效性和安全性。. 方法: 2008 年 7 月—2016 年 6 月采用全脊柱内窥镜技术治疗 96 例合并椎管内骨化的腰椎间盘突出症或腰椎管狭窄症患者。其中男 59 例，女 37 例；年龄 13～57 岁，平均 29.5 岁。病程 3～51 个月，平均 18.2 个月。51 例有明确腰部外伤史。单节段单侧症状 92 例，双侧症状 4 例。骨化性质为椎体后缘离断症 89 例，纤维环或后纵韧带骨化 7 例。骨化为侧方型 32 例，中央型 13 例，混合型 51 例。镜下去除致压因素，如突出的髓核﹑增生黄韧带﹑关节囊或上关节突骨赘结构。椎间孔入路 50 例采用局麻或持续硬膜外麻醉，椎板间入路 46 例采用持续硬膜外麻醉或全麻。术前及末次随访时采用疼痛视觉模拟评分（VAS）评价下肢疼痛程度，末次随访时根据改良 Macnab 标准评定手术疗效。. 结果: 患者手术均顺利完成。经椎间孔入路者手术时间平均 53 min，术中透视次数平均 8 次；经椎板间入路者分别为 58 min 和 3 次。术后卧床时间平均 6.5 h，住院时间平均 4.7 d。术后患者均获随访，随访时间 6～18 个月，中位时间 11 个月。术后 3 d 腰椎 CT 三维重建示，骨化组织未切除 26 例，部分切除 12 例，完全切除 49 例；术后 3 个月腰椎 MRI 示硬膜囊及神经根未见压迫。末次随访时下肢疼痛 VAS 评分为（0.7±1.1）分，较术前的（5.8±1.1）分显著降低（ t=1.987， P=0.025）；根据改良 Macnab 标准评价获优 87 例、良 5 例、可 4 例，优良率 95.8%。. 结论: 全脊柱内窥镜治疗合并椎管内骨化腰椎疾患有效、安全、微创，近期疗效可靠。骨化处理方式应结合症状、影像、风险评估结果综合分析。.
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