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Abstract：
The prognoses of patients who undergo open spinal endoscopy (OSE) decompression significantly differ by scoliosis type and symptom despite the use of uniform standards and procedures for the decompression surgery. These differences may be directly related to the selection and formulation of surgical strategies but their cause remains unclear. The aim of this study was to verify and evaluate the efficacy of the \"Symptom, Stenosis and Segment classification (SSS classification)\" in determining an appropriate surgical strategy and to analyze the differences in the outcomes of different patients after receiving the selected surgical strategy. The results of this study ultimately provide a theoretical basis for the specific optimization of surgical strategies guided by the \"SSS classification\". This work was a retrospective study. We reviewed 55 patients with scoliosis and spinal stenosis who underwent \"pear-shaped\" decompression under OSE from May 2021 to June 2023 treated by our surgical team. To classify different types of patients, we defined the \"SSS classification\" system. The permutation and combination of subtypes in Symptom (including three subtypes: Convex = v, Concave = c and Bilateral = b), Stenosis (including three subtypes: Convex = v, Concave = c and Bilateral = b), and Segment (including two subtypes: Edge = e and Inside = i) yields 18 possible types (details in Table 1) in this classification system. To classify different types of surgeries, we also defined the operation system. The VAS Back and VAS Leg scores after surgical treatment were significantly lower in all patients 3 months after surgery than before surgery. (**P < 0.05). The Svve type accounted for the greatest proportion of patients (62.50%) in the VAS back remission group, and the Scce type accounted for the greatest proportion (57.14%) in the VAS back ineffective group. According to the VAS leg score, the percentage of patients in whom Svve was detected in the VAS leg remission group reached 60.87%, and the percentage of patients in whom Svve was detected in the VAS leg ineffective group reached 44.44%. Svve accounted for the greatest proportion of cases (61.22%) in the JOA-effective group, and Scce accounted for the greatest proportion of cases (50.00%) in the JOA-ineffective group. In the JOA-effective group, the Ovv type accounted for the greatest proportion (up to 79.59%), while in the JOA-ineffective group, Occ and Ovv accounted for 50.00% of the cases each. The proportions of Svve type were the highest in the healthy group (up to 60.00%) and the ODI-effective group (up to 50.00%). The Ovv type accounted for the greatest proportion of patients in the ODI-effective group (up to 80.00%), and the Occ type accounted for the greatest proportion of patients in the ODI-ineffective group (up to 60.00%). Most of the surgical plans formulated by the \"SSS classification\" method were considered appropriate, and only when the symptoms of patients were located on the concave side did the endoscopic decompression plan used in the present study have a limited ability to alleviate symptoms.
摘要：
尽管使用了统一的减压手术标准和程序，但接受开放式脊柱内窥镜（OSE）减压的患者的预后因脊柱侧凸的类型和症状而异。这些差异可能与手术策略的选择和制定直接相关，但其原因尚不清楚。本研究的目的是验证和评估症状的疗效，狭窄和节段分类（SSS分类）在确定适当的手术策略和分析不同患者接受选定的手术策略后的结果差异。本研究结果最终为以“SSS分类”为指导的手术策略的具体优化提供了理论依据。这项工作是一项回顾性研究。我们回顾了我们的手术团队从2021年5月至2023年6月在OSE下接受“梨形”减压的55例脊柱侧弯和椎管狭窄患者。对不同类型的患者进行分类，我们定义了“SSS分类”系统。症状中亚型的排列和组合（包括三个亚型：Convex=v，凹=c和双=b)，狭窄（包括三个亚型：Convex=v，凹=c和双=b)，和Segment（包括两个子类型：Edge=e和Inside=i）在此分类系统中产生18种可能的类型（表1中的详细信息）。为了对不同类型的手术进行分类，我们还定义了操作系统。所有患者术后3个月的VASBack和VASLeg评分均明显低于手术前。(**P<0.05)。在VAS复发缓解组中,Svve型患者所占比例最大(62.50%),在VAS背部无效组中，Scce型占最大比例(57.14%)。根据VAS腿部评分，在VAS腿部缓解组中检测到Svve的患者百分比达到60.87%，在VAS腿无效组中检测到Svve的患者百分比达到44.44％。Svve在JOA有效组中占最大比例（61.22%），在JOA无效组中，Scce占最大比例（50.00%）。在JOA有效组中，Ovv型占最大比例(高达79.59%)，而在JOA无效组，Oc和Ovv各占病例的50.00%。健康组(60.00%)和ODI有效组(50.00%)中Svve型比例最高。Ovv型占ODI有效组患者的最大比例（高达80.00%），ODI无效组患者中OCC型占最大比例(高达60.00%)。大多数由“SSS分类”方法制定的手术计划被认为是适当的，只有当患者的症状位于凹侧时，本研究中使用的内窥镜减压计划缓解症状的能力有限。
