Comparison Of Clinical Efficacy Of Two Different Approaches Of Spinal Endoscopy In The Treatment Of Patients With Single-segment Lumbar Spinal Stenosis

Objective:To compare the clinical efficacy,intraoperative and general conditions,and complications of percutaneous endoscopic interlaminar discectomy and percutaneous endoscopic transforaminal discectomy in the treatment of single-segment lumbar spinal stenosis,so as to provide a reference for the selection of two different approaches of percutaneous endoscopic spinal surgery in clinical work.Methods:1.Study subjects:55 patients diagnosed as L4/5 and L5/S1 single-segment LSS with VAS score≥5 were selected from the Department of Pain,the First Hospital affiliated Anhui Medical University from August 2020 to January 2021.2.Groups:the posterior interlaminar approach group（Group I,n=25）and the lateral intervertebral foramen approach group（Group T,n=30）according to the surgical method.3.Operation methods:The patients in both groups were given 2.0 g of cefmondol sodium intravenously 30 minutes before operation to prevent infection.In group I,PEID was performed under local infiltration anesthesia in prone position,while in group T,PETD was performed under local infiltration anesthesia in contralateral position.4.Outcome measures:4.1 Main outcome measures:The pain and functional recovery of LSS patients in the two groups were compared by recording the VAS score,JOA score and the number of patients with VAS≤3 at each time point before and 1 day,3 months,6 months and 1year after operation;One year after operation,the clinical efficacy was evaluated according to the Mac Nab efficacy evaluation standard.4.2 Secondary indicators:We compared the operation time of the two groups and the fluoroscopy times of the C-arm machine during the operation.Results:There was no significant difference in general condition between the two groups（P>0.05）.There was significant difference in VAS score and degree of reduction at each time point between the two groups(F_time=371.572,P<0.05;F_interaction=2.806,P=0.035),indicating that the pain intensity of the two groups was significantly reduced compared with that before operation,but the degree of reduction was different.There was no statistically significant difference between the two groups in the number of patients with VAS score≤3 at 1 day,3 months,6 months and 1 year after operation（P>0.05）.The difference of JOA score and the degree of reduction at each time point between the two groups was statistically significant(F _time=431.613,P<0.05;F _interaction=4.776,P=0.002),indicating that the two groups had significant functional recovery,but the degree of recovery was different.There was no significant difference in VAS scores between the two groups at 1 day,3 months and 6 months after operation（P>0.05）.At 1 year after operation,the VAS score of patients in group I was lower than that in group T,and the difference was statistically significant（P<0.05）.There was no statistically significant difference in JOA scores between the two groups at 1 day and 3months after operation（P>0.05）.At 6 months and 1 year after operation,the JOA score of group I was higher than that of group T,and the difference was statistically significant（P<0.05）.At the last follow-up,the curative effect of group I was more excellent than that of group T,the difference of the two groups was statistically significant（P<0.05）.Conclusion:Both PEID and PETD can effectively treat LSS,but in the long run,the efficacy of PEID surgery is better than that of PETD,and PEID surgery has the advantages of shorter operation time and fewer intraoperative fluoroscopy times.