Clinical Efficacy Of Percutaneous Endoscopic Transforaminal Decompression Combined With Non-fusion Internal Fixation In Elderly Patients With Degenerative Lumbar Spinal Stenosis With Lumbar Instability

Objective: To investigate the early clinical outcome of percutaneous endoscopic transforaminal decompression(PETD)combined with percutaneous pedicle screw fixation(PPSF)in the treatment of elderly patients diagnosed as degenerative lumbar spinal stenosis(DLSS)with lumbar instability(LI)and to compare the clinical efficacy with that of transforaminal lumbar interbody fusion(TLIF).Methods: We retrospectively reviewed 63 patients diagnosed as DLSS with LI who attended the Affiliated Hospital of Chengde Medical University from September 2018 to November 2019,33 cases of whom were treated with PETD with PPSF(Group A)and 30 cases were treated with TLIF(Group B).The sex,age,responsible segment,co-morbidities and perioperative data were recorded in both groups,respectively.Back and low extremities pain was rated using the visual analog scale(VAS),and the degree of the patient’s disability and life function were assessed oswestry disability index(ODI)and japanese orthopaedic association(JOA)scores.These scores were recorded at preoperatively,1 day postoperatively,3 months postoperatively,6 months postoperatively and 1 year postoperatively,respectively.Overall clinical outcome was assessed by modified Macnab criteria at the final follow-up.Surgery-related complications were recorded in both groups.Results: Patients undergoing PETD with PPSF had much less postoperative bed rest(1.64±0.65 days),hospital stay(10.27±3.10 days)and intraoperative bleeding(135.76±32.41 ml)than patients undergoing TLIF(P<0.05),and no obvious difference in the operation time between the two groups of patients was found by statistical tests(P>0.05).Postoperative pain scores and clinical function scores improved substantially in both groups compared to preoperative scores(P < 0.05).Besides,patients in group A showed better back VAS,lower extremities VAS ODI,and JOA scores than those in another group at 1 day,3 months,and 6 months postoperatively(P<0.05).While the overall recovery at 1 year postoperatively was generally similar in both groups(P>0.05).At the final follow-up,the overall clinical outcome was evaluated based on the modified Macnab criteria: the excellent rate was 93.94% in group A and 90% in group B(P > 0.05).In the group A,one case of dura mater laceration occurred intraoperatively,and no serious complications such as irreversible nerve injury and internal fixation failure occurred in the postoperative follow-up.And one patient in group B was diagnosed as cerebral infarction after surgery,and five patients had incisional complications.The minimally invasive surgery group still had lower rates of postoperative anemia,incision-related complications and overall adverse events than the traditional open surgery group,the difference was statistically significant(P < 0.05).Conclusion: PETD with PPSF for the treatment of elderly patients diagnosed with DLSS with LI is a reasonable minimally invasive surgical option with complete decompression and overall efficacy comparable to that of traditional TLIF,with the advantages of rapid recovery and less surgical blow.