Abstract：
Endoscopic spine surgery is a globally expanding technique advocated as less invasive for spinal stenosis treatment compared to the microsurgical approach. However, evidence on the efficiency of interlaminar full-endoscopic decompression (FED) vs. conventional microsurgical decompression (MSD) in patients with lumbar spinal stenosis is still scarce. We conducted a case-matched comparison for treatment success with consideration of clinical, laboratory, and radiologic predictors.
We included 88 consecutive patients (FED: 36/88, 40.9%; MSD: 52/88, 59.1%) presenting with lumbar central spinal stenosis. Surgery-related (operation time, complications, length of stay (LOS), American Society of Anesthesiologists physical status (ASA) score, C-reactive protein (CRP), white blood cell count, side of approach (unilateral/bilateral), patient-related outcome measures (PROMs) (Oswestry disability index (ODI), numeric rating scale of pain (NRS; leg-, back pain), EuroQol questionnaire (eQ-5D), core outcome measures index (COMI)), and radiological (dural sack cross-sectional area, Schizas score (SC), left and right lateral recess heights, and facet angles, respectively) parameters were extracted at different time points up to 1-year follow-up. The relationship of PROMs was analyzed using Spearman\'s rank correlation. Surgery-related outcome parameters were correlated with patient-centered and radiological outcomes utilizing a regression model to determine predictors for propensity score matching.
Complication (most often residual sensorimotor deficits and restenosis due to hematoma) rates were higher in the FED (33.3%) than MSD (13.5%) group (p < 0.05), while all complications in the FED group were observed within the first 20 FED patients. Operation time was higher in the FED, whereas LOS was higher in the MSD group. Age, SC, CRP revealed significant associations with PROMs. We did not observe significant differences in the endoscopic vs. microsurgical group in PROMs. The correlation between ODI and COMI was significantly high, and both were inversely correlated with eQ-5D, whereas the correlations of these PROMs with NRS findings were less pronounced.
Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach. Although FED was associated with higher complication rates in our single-center study experience, the distribution of complications indicated surgical learning curves to be the main factor of these findings. Future long-term prospective studies considering the surgical learning curve are warranted for reliable comparisons of these techniques.
We included 88 consecutive patients (FED: 36/88, 40.9%; MSD: 52/88, 59.1%) presenting with lumbar central spinal stenosis. Surgery-related (operation time, complications, length of stay (LOS), American Society of Anesthesiologists physical status (ASA) score, C-reactive protein (CRP), white blood cell count, side of approach (unilateral/bilateral), patient-related outcome measures (PROMs) (Oswestry disability index (ODI), numeric rating scale of pain (NRS; leg-, back pain), EuroQol questionnaire (eQ-5D), core outcome measures index (COMI)), and radiological (dural sack cross-sectional area, Schizas score (SC), left and right lateral recess heights, and facet angles, respectively) parameters were extracted at different time points up to 1-year follow-up. The relationship of PROMs was analyzed using Spearman\'s rank correlation. Surgery-related outcome parameters were correlated with patient-centered and radiological outcomes utilizing a regression model to determine predictors for propensity score matching.
Complication (most often residual sensorimotor deficits and restenosis due to hematoma) rates were higher in the FED (33.3%) than MSD (13.5%) group (p < 0.05), while all complications in the FED group were observed within the first 20 FED patients. Operation time was higher in the FED, whereas LOS was higher in the MSD group. Age, SC, CRP revealed significant associations with PROMs. We did not observe significant differences in the endoscopic vs. microsurgical group in PROMs. The correlation between ODI and COMI was significantly high, and both were inversely correlated with eQ-5D, whereas the correlations of these PROMs with NRS findings were less pronounced.
Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach. Although FED was associated with higher complication rates in our single-center study experience, the distribution of complications indicated surgical learning curves to be the main factor of these findings. Future long-term prospective studies considering the surgical learning curve are warranted for reliable comparisons of these techniques.
摘要：
目的：内窥镜脊柱手术是一种在全球范围内扩展的技术，与显微外科手术方法相比，其对于椎管狭窄的治疗具有较小的侵入性。然而,层间全内镜减压术(FED)疗效与传统的显微手术减压术（MSD）在腰椎管狭窄症患者中仍然很少。我们进行了一个病例匹配的比较治疗的成功与临床考虑，实验室,和放射学预测因子。
方法：我们纳入了88例表现为腰椎中央椎管狭窄的连续患者（FED：36/88，40.9%；MSD：52/88，59.1%）。手术相关(手术时间，并发症,停留时间(LOS)美国麻醉医师协会身体状况（ASA）评分，C反应蛋白(CRP),白细胞计数,方法方面(单边/双边)，患者相关结局指标(PROM)(Oswestry残疾指数(ODI)，疼痛数字评定量表(NRS；腿部-，背部疼痛)，EuroQol问卷(eQ-5D)，核心成果计量指数(COMI))，和放射学(硬脑膜袋横截面积，Schizas得分（SC），左右横向凹陷高度，和刻面角度，分别)在不同时间点提取参数，直至1年随访。使用Spearman秩相关分析了PROM之间的关系。手术相关的结果参数与以患者为中心和放射学结果相关，利用回归模型确定倾向评分匹配的预测因子。
结果：并发症（最常见的是血肿引起的残余感觉运动功能障碍和再狭窄）发生率在FED组（33.3％）高于MSD组（13.5％）（p<0.05），而FED组的所有并发症均在前20例FED患者中观察到。FED的手术时间较高，而MSD组的LOS较高。年龄,SC,CRP显示与PROMs有显著关联。我们没有观察到内镜与显微外科手术组的ODI和COMI之间的相关性显著高，两者都与eQ-5D呈负相关，而这些PROM与NRS结果的相关性不太明显。
结论：内窥镜治疗腰椎管狭窄症与传统的显微外科手术方法相似。尽管在我们的单中心研究经验中，FED与较高的并发症发生率相关，并发症的分布表明手术学习曲线是这些发现的主要因素.考虑手术学习曲线的未来长期前瞻性研究对于这些技术的可靠比较是必要的。
方法：我们纳入了88例表现为腰椎中央椎管狭窄的连续患者（FED：36/88，40.9%；MSD：52/88，59.1%）。手术相关(手术时间，并发症,停留时间(LOS)美国麻醉医师协会身体状况（ASA）评分，C反应蛋白(CRP),白细胞计数,方法方面(单边/双边)，患者相关结局指标(PROM)(Oswestry残疾指数(ODI)，疼痛数字评定量表(NRS；腿部-，背部疼痛)，EuroQol问卷(eQ-5D)，核心成果计量指数(COMI))，和放射学(硬脑膜袋横截面积，Schizas得分（SC），左右横向凹陷高度，和刻面角度，分别)在不同时间点提取参数，直至1年随访。使用Spearman秩相关分析了PROM之间的关系。手术相关的结果参数与以患者为中心和放射学结果相关，利用回归模型确定倾向评分匹配的预测因子。
结果：并发症（最常见的是血肿引起的残余感觉运动功能障碍和再狭窄）发生率在FED组（33.3％）高于MSD组（13.5％）（p<0.05），而FED组的所有并发症均在前20例FED患者中观察到。FED的手术时间较高，而MSD组的LOS较高。年龄,SC,CRP显示与PROMs有显著关联。我们没有观察到内镜与显微外科手术组的ODI和COMI之间的相关性显著高，两者都与eQ-5D呈负相关，而这些PROM与NRS结果的相关性不太明显。
结论：内窥镜治疗腰椎管狭窄症与传统的显微外科手术方法相似。尽管在我们的单中心研究经验中，FED与较高的并发症发生率相关，并发症的分布表明手术学习曲线是这些发现的主要因素.考虑手术学习曲线的未来长期前瞻性研究对于这些技术的可靠比较是必要的。
