| BackgroundLumbar spinal stenosis is a syndrome of vascular and nerve compression caused by one or more causes,and it can leads to a series of symptoms.As one of the main causes of low back pain and leg pain in the elderly,it continuously affects people’s lives,physical health and mental health.The clinical treatment of lumbar spinal stenosis is constantly controversial.In the past,it was believed that lumbar spinal stenosis was mainly caused by degenerative causes.It has a long course and slow development.The use of medications often fails to remove the cause,so it is recommended early surgical treatment.With people’s further understanding of lumbar spinal stenosis,and a large number of clinical trials of many scholars on the treatment of lumbar spinal stenosis,we find that it is necessary to conduct a standard conservative treatment before surgery for a period of time.If conservative treatment can not achieve satisfactory results,surgical treatment is recommended.The surgical treatment of lumbar spinal stenosis has developed since the 1880s when a doctor named Lane performed lumbar decompression surgery on patients with cauda equina syndrome.After a long period of development,total laminectomy has gradually matured and has become the most classic operation for the treatment of lumbar spinal stenosis.Until now,it has been widely used in clinical applications.Indeed,total laminectomy,as an open procedure,can completely decompress the nerves and relieve the patient’s pain.However,with the study of a large number of clinical trials and the application of biomechanics to spine medicine,it has been found that total laminectomy has caused many complications due to damage to the posterior midline structure and tissue of the lumbar spine.In order to reduce complications,doctors continue to try new procedures to treat lumbar spinal stenosis.For a while,the spine medicine community has blossomed,and so far,hundreds of surgical methods have been developed.However,according to the current literature review,there is no single surgical method that can be used as the most effective treatment for spinal stenosis.Therefore,finding a surgical method with accurate curative effect,safety,reliability and few complications has become an unsolvable difficulty in spine surgery.In the 1990s,endoscopic technology began to flourish,bringing people a new treatment method for surgery-minimally invasive technology.Compared with traditional open surgery,minimally invasive technology has many advantages,such as less trauma,less bleeding,shorter operation time,faster recovery and so on.It is also widely welcomed by patients.We combined a minimally invasive concept to design an modified laminoplasty technique to share with all my colleagues in spine surgery.PurposeTo describe the surgical method of endoscopic modified total laminoplasty for lumbar spinal stenosis and to explore its early efficacy.MethodA analysis of 22 patients with lumbar spinal stenosis who underwent endoscopic modified total laminoplasty during the period from August 2016 to August 2017 in the First Affiliated Hospital of Zhengzhou University was made.There were 8 males and 14 females with an average age of 59.3±9.6 years.All 22 patients were followed up for 1 to 2 years,with an average follow-up time of 18.3 months,of which 9 patients were lost to follow-up after one year of follow-up.There were 22 patients with neurogenic intermittent claudication,and the average claudication distance was 339±130m.ResultAll cases were followed up for 1 year to 2 years,with an average follow-up time of 18.3 months.Complications include intraoperative dural tears(n=1),and weak fusion between the lamina and the vertebral body(n=1).There was a statistically significant difference of VAS lower limb pain and back pain,ODI and JOA scores between before surgery and 1 year after surgery(p<0.001).ConclusionEndoscopic modified total laminectomy is effective in the treatment of symptomatic lumbar spinal stenosis,and it is safe enough to be used in clinical. |
PDF Full Text Request