These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [Percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for lumbar spinal stenosis].
    Author: Xin Z, Cai M, Ji W, Chen L, Kong W, Li J, Qin J, Wang A, Ao J, Liao W.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2019 Jul 15; 33(7):822-830. PubMed ID: 31297998.
    Abstract:
    OBJECTIVE: To design the surgical strategy of percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral lumbar spinal stenosis (LSS) and to evaluate the effectiveness. METHODS: The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral LSS was designed according to the pathological features of LSS. The technique was used to treat 42 patients with LSS between January 2016 and January 2018. There were 18 males and 24 females with an average age of 61.7 years (range, 46-81 years). The duration of symptoms was 1-20 years, with an average of 9.7 years. The surgical segment at L 4, 5 were 27 cases, at L 5, S 1 were 15 cases. The operation time and perioperative complications were recorded. Lumbar X-ray, CT, and MRI examinations were performed at 1 week, 3 months, and 1 year after operation. Visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain, Oswestry disability index (ODI) was used to evaluate the lumbar function, and single continuous walking distance (SCWD) was used to evaluate lower extremity nerve function. The clinical efficacy was evaluated by MacNab criteria at 1 year after operation. RESULTS: All patients underwent surgery successfully. The operation time was 68-141 minutes with an average of 98.2 minutes. All 42 patients were followed up 12-24 months with an average of 18.8 months. There were 2 cases of dural tears during operation, and 1 case of transient dysfunction of the lower limbs of the decompression channel after operation. All of them were cured after corresponding treatment. No serious complications such as death, major bleeding, or irreversible nerve injury occurred during follow-up. No segmental instability was found according to postoperative lumbar hyperextension and flexion X-ray films, and postoperative CT and MRI imaging showed that the stenotic lumbar spinal canal was significantly enlarged, and the compression of the nerve root was sufficient. The VAS score of low back pain and leg pain, ODI score, and SCWD at each time point after operation were significantly improved when compared with those before operation ( P<0.05); the indexes were significantly improved over time after operation, and the differences were significantly ( P<0.05). The clinical efficacy was evaluated by MacNab standard at 1 year after operation, and the results were excellent in 18 cases, good in 20 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 90.5%. CONCLUSION: The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for LSS is a safe and effective procedure. A well-designed surgical strategy and mastery of its technical points are important guarantees for successful operation and satisfactory results. 目的: 设计后路经皮全内镜技术单侧入路双侧减压治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的手术策略，并评价临床应用效果。. 方法: 针对 LSS 病理特征设计后路经皮全内镜技术单侧入路双侧减压手术策略，并于 2016 年 1 月—2018 年 1 月应用该技术治疗 42 例 LSS 患者。男 18 例，女 24 例；年龄 46～81 岁，平均 61.7 岁。病程 1～20 年，平均 9.7 年。手术节段：L 4、5 27 例，L 5、S 1 15 例。记录患者手术时间及围手术期并发症情况，并于术后 1 周、3 个月及 1 年行腰椎 X 线片、CT 和 MRI 检查。采用疼痛视觉模拟评分（VAS）评价腰腿痛，Oswestry 功能障碍指数（ODI）评价腰部功能，应用单次连续步行距离（single continuous walking distance，SCWD）评价下肢神经功能，术后 1 年采用 MacNab 标准对临床疗效进行评价。. 结果: 所有患者均顺利完成手术，手术时间 68～141 min，平均 98.2 min。42 例患者均获随访，随访时间 12～24 个月，平均 18.8 个月。术中发生硬脊膜撕裂 2 例，术后减压通道对侧下肢短暂感觉障碍 1 例，均经相应处理后治愈。随访期间无死亡、大出血及不可逆性神经损伤等严重并发症发生。术后腰椎过伸过屈位 X 线片未发现不稳征象；CT 及 MRI 显示术前狭窄的椎管扩大明显，卡压神经根松解充分。术后各时间点腰腿痛 VAS 评分、ODI 评分、SCWD 均较术前显著改善（ P<0.05）；术后随时间推移各指标均显著改善，各时间点间两两比较差异均有统计学意义（ P<0.05）。术后 1 年采用 MacNab 标准评价临床疗效，获优 18 例、良 20 例、可 3 例、差 1 例，优良率为 90.5%。. 结论: 后路经皮全脊柱内镜技术单侧入路双侧减压治疗 LSS 是安全、有效的术式，设计合理的手术策略及熟练掌握其技术要点是手术顺利进行并获得满意疗效的重要保障。.
    [Abstract] [Full Text] [Related] [New Search]