内镜下保留黄韧带单侧椎板切开双侧隐窝减压术:手术技术和临床结果【文献速递】

Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results

内镜下保留黄韧带单侧椎板切开双侧隐窝减压术:手术技术和临床结果

Objective: Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD).

Methods: Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well.

Results: Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported(7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up.

Conclusion: ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.

Keywords: Endoscopic spine surgery, Lateral recess stenosis, Radiculopathy, Minimally invasive spine surgery, Interlaminar endoscopic lateral recess decompress

目的:

椎板间内窥镜脊柱手术已被引入并用于腰椎外侧隐窝减压。我们改进了这项技术，并将其用于双侧侧隐窝狭窄，没有明显的中央狭窄。在此我们报道保留黄韧带单侧椎板切开术双侧隐窝减压(ULBRD)的手术细节和临床结果。

方法:

回顾前瞻性收集的内镜手术登记。2015年9月至2021年3月期间，来自单一中心的182例连续病例被回顾，其中57例接受ULBRD的患者被纳入分析。回顾了基本的患者人口学数据、围手术期细节、手术相关并发症和临床结果。详细的手术技术也被提出。

结果:

在入选的57例患者中，37例为男性，20例为女性。平均年龄为58.53±14.51岁，年龄在50岁中期和60岁中期及以上呈双峰分布。年龄峰值较晚与退行性脊柱侧凸并存有关。平均每片手术时间70.34±20.51 min，平均住院时间0.56±0.85 d。围手术期并发症4例(7.0%)，1年内指标水平的总再手术率为8.8%。术前背部/腿部视觉模拟量表评分和功能结局量表(包括EuroQol-5维度问卷、Oswestry功能障碍指数)术后立即有显著改善，并维持至末次随访。

结论:

双侧侧隐窝狭窄无明显中心狭窄的ULBRD临床效果良好，围手术期并发症发生率低。充分减压，保留中央黄韧带。

关键词:

脊柱内窥镜手术，侧隐窝狭窄，神经根病，微创脊柱手术，椎板间内窥镜侧隐窝减压