| Objective:To explore the efficacy and safety of unilateral laminotomy for bilateral decompression through interlaminar approach under percutaneous large diameter endoscopy and posterior lumbar interbody fusion in the treatment of single-segment lumbar spinal stenosis,and to compare the two methods to provide a better surgical option for the treatment of single-segment lumbar spinal stenosis.Method:The clinical data of patients who underwent unilateral laminotomy for bilateral decompression through interlaminar approach under percutaneous large diameter endoscopy and posterior lumbar interbody fusion for single-segment lumbar spinal stenosis at Affiliated Hospital of Yangzhou University from January 2018 to December 2021,were retrospectively analyzed.A total of 86 patients were included based on inclusion and exclusion criteria,of whom 5 patients were lost to follow-up during the study period and 2 patients could not provide complete follow-up data,resulting in 79 patients completing the study.Of these,41 patients were included in the large-channel endoscopic lumbar decompression group(large-channel group),including 22 males and 19 females,with a mean age range of 73.32±4.75 years.Thirty-eight patients were included in the posterior lumbar interbody fusion group(PLIF group),including 21 males and 17 females,with a mean age range of 73.581±5.05 years.Both groups of patients underwent successful surgeries and were followed up for more than 1 year to evaluate surgical outcomes.Data on surgical time,incision length,intraoperative blood loss,and other indicators were compared between the two groups.The dural sac area before and after surgery,serum creatine kinase level,visual analog pain score(VAS),Oswestry Disability Index(ODI),modified MacNab evaluation criteria,and complications were also evaluated and compared between the two groups.ResultBoth groups were followed up for more than 1 year,and there were no significant differences in gender,age,course of disease,body mass index,surgical segment,underlying disease,and other data between the two groups(P>0.05).The operation time of the large channel group(105.37±20.54 minutes)was shorter than that of the PLIF group(218.56±20.33 minutes).Intraoperative blood loss was 17.80±4.48 ml in the large channel group and 270.53±67.50 ml in the PLIF group,and the blood loss in the large channel group was significantly lesser than that in the PLIF group.The hospitalization time was 3.51±0.74 days in the large channel group and 14.74±1.50 days in the PLIF group,and the hospitalization time in the large channel group was shorter than in the PLIF group.The above four differences were statistically significant(P<0.05).During the follow-up period,the areas of the average dural sac expansion area after the operation in both groups were increased compared with those before the operation(P<0.05),but there was no significant difference in the expanded area of the dural sac between the two groups(P>0.05).The postoperative serum creatine kinase levels in the two groups were higher than those before the operation(P<0.05),and the serum creatine kinase levels in the PLIF group were higher than those in the large channel group on day 1 and 7 after the operation,and the difference was statistically significant(P<0.05).At 1 week,3 months,and 12 months after the operation,the visual analogue scale(VAS score)for back and leg pain and the Oswestry disability index(ODI score)in the two groups were better than those before the operation(P<0.05).The VAS score for back and the ODI score was lower in the large channel group than in the PLIF group at 1 week after operation,and the difference was statistically significant(P<0.05).At other time points,there was no significant difference between the two groups in VAS score for lumbar and leg pain and Oswestry disability index(P>0.05).During the 12-month follow-up,the excellent and good rates of the modified MacNab evaluation criteria were 87.80%in the large channel group and 89.47%in the PLIF group,and there was no significant difference between the two groups(P>0.05).Additionally,one patient in the large channel group suffered from intraoperative dural sac tear,but after timely treatment,there was no abnormality in follow-up,and no intraoperative or postoperative complications occurred in the remaining patients.ConclusionBoth large channel endoscopic lumbar decompression and posterior lumbar interbody fusion can achieve good results in the treatment of lumbar spinal stenosis,but the long-term efficacy(more than 1 year)still needs further research.Large-channel endoscopy has advantages in shortening operation time,hospitalization time,intraoperative blood loss,surgical incision,muscle damage,and postoperative short-term(1 week)lumbar pain,which is worthy of promotion. |
PDF Full Text Request