Clinical Study On Degenerative Lumbar Spinal Stenosis By Endoscopic Lumbar Fusion Via Two Approaches Based On The Theory Of "Combining Tendon And Bone"

Objective:1.To study the therapeutic effects of endoscopic lumbar spinal fusion via interlaminar and transforaminal approaches in the treatment of degenerative lumbar spinal stenosis based on the theory of "tendon and bone together".2.To compare the indices of the two different surgical approaches in clinical treatment and provide guidance for the selection of the approach in clinical treatment.Methods:A retrospective study was conducted to select patients with degenerative lumbar spinal stenosis who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine and treated with endoscopic lumbar fusion from 07/2020 to 07/2022.70 patients were screened according to the inclusion and exclusion criteria and divided into two groups according to the surgical access,one group was the trans-laminar access group and one group was the trans-intervertebral foraminal access group,with 35 patients in each group.The perioperative data of patients in both groups were collected,including intraoperative data such as operative time,number of intraoperative fluoroscopy,total length of surgical incision,bone graft volume,height of Cage placed,and postoperative data such as postoperative hemoglobin reduction,postoperative bed rest time,etc.The efficacy evaluation indexes included VAS,JOA,ODI scores at admission,1 month postoperatively,3 months postoperatively,6 months postoperatively,and the last follow-up satisfaction,effective upper endplate area,intervertebral space improvement,and lumbar fusion.The statistical software SPSS25.0 was used to analyze the above information collected.Results:1.There was no significant difference between the two groups in terms of general information such as gender,age,and duration of disease,P>0.05;there was no significant difference between the two groups in terms of preoperative functional evaluation indexes such as VAS,ODI,and JOA,P>0.05.2.The patients in the transvertebral interlaminar approach group had a significant advantage in terms of operative time,total length of the surgical incision,and lower postoperative hemoglobin reduction compared with the transvertebral foraminal approach group,P<0.05.P<0.05;intraoperative bone grafting was more in the trans-laminar access group,and the difference between the group with transintervertebral foraminal access was statistically significant,P<0.05;there was no significant difference in the number of intraoperative fluoroscopy,postoperative bed rest time,and intraoperative Cage height placement between the two groups,P>0.05.3.The scores of VAS,JOA,and ODI were significantly better than the preoperative scores in each postoperative period in the two groups,and the difference was There was no significant difference between the two groups in terms of satisfaction at the last follow-up,effective upper endplate area,and lumbar fusion at 6 months after surgery,P>0.05;both groups improved the intervertebral space height,P<0.05,but the transvertebral interlaminar approach group was more advantageous than the transvertebral interlaminar approach group,P<0.05.access group was more advantageous,and the difference with the transvertebral foraminal access group was statistically significant,P<0.05.Conclusions:1.Endoscopic lumbar fusion with both transvertebral foraminal approach and translaminar approach has good therapeutic effect on degenerative lumbar spinal stenosis.2.Translaminar approach can decompress the contralateral nerve root and is better than transvertebral foraminal approach in reducing contralateral symptoms.3.Compared with transvertebral foraminal approach,translaminar approach has the advantages of shorter operative time,less bleeding,larger bone graft,and significant improvement in vertebral space height.Compared with the transforaminal approach,the transforaminal approach has the advantage...