背景:邻段疾病(ASD)是后路椎间盘减压和融合手术后的常见并发症。经皮内窥镜腰椎减压手术(PELD)已用于通过经椎间孔或层间入路治疗ASD。然而,根据我们有限的知识,没有报告比较两种治疗ASD的方法。
目的:评估PELD治疗ASD的临床效果,并比较两种方法的手术效果和并发症。这可能有助于脊柱外科医生在决定ASD治疗时。
方法:临床回顾性研究。
方法:本研究在青岛大学附属医院骨科进行。
方法:从2015年1月至2019年12月,共68例ASD患者在腰椎后路减压融合手术后接受PELD治疗。根据所采用的方法,将患者分为经皮内镜下椎间孔减压(PETD)组和经皮内镜下椎间减压(PEID)组。人口特征,放射学和临床结果,通过图表回顾记录两组的并发症.
结果:在68例患者中,40例患者接受PEID,28例患者接受PETD。与术前视觉模拟量表(VAS)疼痛评分和Oswestry残疾指数(ODI)评分比较,所有患者术后3个月均有显著改善,6个月,一年和最新的后续行动。PETD组和PEID组VAS和ODI评分差异无统计学意义,P>0.05。PETD组和PEID组的平均透视次数差异有统计学意义,P=0.000。8例患者进行了翻修手术:6例接受PETD的患者和2例接受PEID的患者。2种方法之间的修订率显示出显着的统计学差异,P值=0.039。
结论:首先,纳入本研究的患者数量较少.需要更多的患者进行进一步的研究。其次,本研究的随访时间有限.关于用器械进行初次减压是否会增加PELD后的再手术率,目前尚无定论。未来需要更长时间的随访。第三,本研究为临床回顾性研究.为了获得更高水平的证据,未来需要随机或对照试验。第四,有关于ASD的PELD方法选择的辩论,这可能会影响PETD和PEID之间的比较结果。在我们的研究中,方法主要取决于椎间盘突出的程度和类型,和外科医生的偏好。将来需要更多患有不同程度和类型的椎间盘突出症和手术方法的ASD患者来消除这些偏见。
结论:经皮内窥镜下腰椎减压手术是一种可行的选择。与PETD相比,PEID似乎是治疗有症状的ASD的更好方法。
BACKGROUND: Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD.
OBJECTIVE: To evaluate clinical outcomes of PELD in treating ASD and comparing the surgical results and complications between the 2 approaches. This may be helpful for spinal surgeons when decision-making ASD treatment.
METHODS: A clinical retrospective
study.
METHODS: This study was conducted at the Department of Orthopedics of the Affiliated Hospital of Qingdao University.
METHODS: From January 2015 through December 2019, a total of 68 patients with ASD who underwent PELD after lumbar posterior decompression with fusion surgery were included in this study. The patients were divided into a percutaneous endoscopic transforaminal decompression (PETD) group and a percutaneous endoscopic interlaminar decompression (PEID) group according to the approach used. The demographic characteristics, radiographic and clinical outcomes, and complications were recorded in both groups through a chart review.
RESULTS: Of the 68 patients, 40 underwent PEID and 28 patients underwent PETD. Compared with their preoperative Visual Analog Scale (VAS) pain score and Oswestry Disability Index (ODI) score, all patients had significant postoperative improvement at 3 months, 6 months, one year and at the latest follow-up. There were no significant statistical differences in the VAS and ODI scores between PETD and PEID groups with a P value > 0.05. There was a significant statistical difference in the average fluoroscopy times between the PETD and PEID groups with a P value = 0.000. Revision surgery occurred in 8 patients: 6 patients who underwent PETD and 2 patients who underwent PEID. The revision rate showed a significant statistical difference between the 2 approaches with a P value = 0.039.
CONCLUSIONS: Firstly, the number of patients included in this
study was small. More patients are needed in a further
study. Secondly, the follow-up time was limited in this
study. There is still no conclusion about whether the primary decompression with instruments will increase the reoperation rate after a PELD, and a longer follow-up is needed in the future. Thirdly, this
study was a clinical retrospective
study. Randomized or controlled trials are needed in the future in order to achieve a higher level of evidence. Fourthly, there were debates about PELD approach choices for ASDs, which may affect the comparison results between PETD and PEID. In our study, the approaches were mainly determined by the level and types of disc herniation, and the surgeons\' preference. More patients with an ASD with different levels and types of disc herniation and surgical approaches are needed in the future to eliminate these biases.
CONCLUSIONS: Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs.