目的:探讨腰椎椎间孔狭窄(LFS)患者行全镜下腰椎椎间孔切开术(FELF)术后再狭窄的相关危险因素。
方法:单中心,我们对2019年8月至2022年4月期间诊断为椎间孔狭窄且接受FELF的患者进行了回顾性病例对照研究.该研究包括56名患者,包括18个病例和38个对照。临床数据,放射学评估,比较两组的手术类型。研究了区分2组的放射学参数的截止值。
结果:年龄无显著差异,性别分布,或在组间观察到相邻节段疾病或I级腰椎滑脱。病例的椎间盘楔入角(DWA)程度较高(3.0°±1.1°与0.5°±1.4°,p<0.001),较大的冠状Cobb角(CCA)(8.8°±5.1°与4.7°±2.5°,p=0.004),和较小的节段腰椎前凸(SLL)比对照组(11.0±7.4vs.18.0±5.4,p=0.001)。DWA的最佳截止值,CCA,SLL估计为1.8°,7.9°,和17.1°,分别。病例和对照组之间的手术类型存在显着差异(p=0.004),病例组除TELF外还接受椎间盘切除术的患者分布较高。
结论:该研究确定了LFS患者FELF术后再狭窄的潜在危险因素,包括更高的DWA,较大的CCA,更小的SLL角度。我们认为在FELF期间应谨慎进行椎间盘切除术,因为它会导致随后的再狭窄。
OBJECTIVE: To investigate risk factors associated with postoperative
restenosis after full endoscopic lumbar foraminotomy (FELF) in patients with lumbar foraminal stenosis (LFS).
METHODS: A single-center, retrospective
case-control study was conducted on patients diagnosed with foraminal stenosis who underwent FELF between August 2019 and April 2022. The study included 56 patients, comprising 18 cases and 38 controls. Clinical data, radiologic assessments, and surgical types were compared between the groups. The cutoff values of radiologic parameters that differentiate the 2 groups were investigated.
RESULTS: No significant difference in age, sex distribution, or presence of adjacent segment disease or grade I spondylolisthesis was observed between the groups. Cases had a higher degree of disc wedging angle (DWA) (3.0° ± 1.1° vs. 0.5° ± 1.4°, p < 0.001), larger coronal Cobb angle (CCA) (8.8° ± 5.1° vs. 4.7° ± 2.5°, p = 0.004), and smaller segmental lumbar lordosis (SLL) than controls (11.0 ± 7.4 vs. 18.0 ± 5.4, p = 0.001). Optimal cutoff values for DWA, CCA, and SLL were estimated as 1.8°, 7.9°, and 17.1°, respectively. A significant difference in surgical types was observed between cases and controls (p = 0.004), with the
case group having a higher distribution of patients undergoing discectomy in addition to TELF.
CONCLUSIONS: The study identified potential risk factors for
restenosis after FELF in patients with LFS, including higher DWA, larger CCA, smaller SLL angle. We believe that discectomy should be perform with caution during FELF, as it can lead to subsequent
restenosis.