经皮椎间孔镜椎板间入路与椎间孔入路治疗腰椎管狭窄症

腰椎管狭窄症是老年人常见病、多发病。手术方式包括开放手术和微创手术。椎间孔镜以其创口小、疼痛轻及恢复快的特点已成为目前治疗腰椎管狭窄症的微创手术首选器械。其手术入路主要分为经皮椎板间入路和经皮椎间孔入路,然而这两种手术入路各有优缺点及适应证。在实际的临床工作中选择椎间孔镜治疗腰椎管狭窄症时,对不同病理类型的腰椎管狭窄症选用合适的手术入路进行治疗,是达到良好手术效果的前提。     

经后路椎体间融合术与经椎间孔椎体间融合术治疗老年退行性腰椎滑脱合并腰椎管狭窄症的疗效

目的探讨经后路椎体间融合术(PLIF)与经椎间孔椎体间融合术(TLIF)治疗老年退行性腰椎滑脱合并腰椎管狭窄症的临床疗效。方法选取2011年12月至2012年12月该院收治的老年退行性腰椎滑脱合并腰椎管狭窄症患者40例,根据手术方式将患者分为PLIF组(n=21)和TLIF组(n=19),比较两组手术时间、术中出血量、术后引流量、术后卧床时间、视觉疼痛评分(VAS)、Oswestry功能不良指数(ODI)及并发症。结果TLIF组术中出血量、术后引流量以及术后卧床时间均显著优于PLIT组(P0.05),两组手术时间比较无统计学意义(P0.05);两组术后半年VAS评分以及ODI评分均显著优于术前(P0.05),但组间差异无统计学意义(P0.05);TLIF组并发症发生率显著低于PLIF组(P0.05)。结论TLIF治疗老年退行性腰椎滑脱合并腰椎管狭窄症较PLIT临床疗效更佳,且术后并发症更少。     

单节段经椎间孔腰椎椎间融合术椎间融合器植入与单纯自体颗粒骨植骨治疗老年退变性腰椎管狭窄症的疗效

目的探讨经椎间孔入路微创单节段腰椎椎间融合术椎间融合器植入或单纯自体颗粒骨植骨两种融合方式治疗老年退变性腰椎管狭窄症的疗效。方法选取2011年3月至2012年7月该院骨科收治的拟接受经椎间孔入路的单节段腰椎椎间融合术的老年腰椎管狭窄症患者74例,随机分为融合器组和植骨组各37例。记录两组手术时间、术中出血量、术后住院时间、治疗费用;分别于手术前、术后1 w、1年、2年进行随访,比较数字分级法(VAS)评分、Oswestry功能障碍指数问卷表(ODI)评分、椎间孔和椎间隙高度、腰椎前凸角、融合率、术后并发症情况。结果两组手术时间、术后住院时间、术中出血量之间均无统计学差异(P>0.05);融合器组患者治疗费用明显高于植骨组(P<0.05)。两组患者术后1年、2年的VAS评分、ODI评分与术前相比均明显降低(P<0.05);术后1年和术后2年的VAS评分、ODI评分两组间均无统计学差异(P>0.05)。融合器组术后2年椎间孔高度、椎间隙高度明显高于植骨组(P<0.05);两组术后2年腰椎前凸角度之间无统计学差异(P>0.05)。两组患者术后1年、2年融合率、术后并发症发生率差异均无统计学差异(P>0.05)。结论老年单节段退变性腰椎管狭窄症患者行微创经椎间孔入路的单节段腰椎椎间融合术治疗,椎间融合器植骨能够更好地恢复椎间隙、椎间孔的高度;自体颗粒骨植骨具有明显的经济优势。     

降钙素治疗腰椎管狭窄症的机制

降钙素(calcitonin,CT)是由人甲状腺滤泡旁C细胞分泌的多肽,在人体内与CT受体结合发挥生理作用.临床中常用的CT是鲑鱼和鳗鱼降钙素.主要用于治疗高钙血症和骨质疏松相关的疼痛.有研究者发现CT在治疗腰椎管狭窄症时可获得较好的疗效.但是也有临床研究得出相反的结论,其确切疗效仍存在争议.本文通过介绍CT生理作用、...     

全椎板切除脊柱内固定治疗老年退行性腰椎管狭窄症的疗效

老年退行性腰椎管狭窄症是老年骨科常见的疾病之一,主要的临床表现是由于神经根受压而导致患者出现腰腿痛.对于大部分患者来说,病变较严重,病程较长,保守治疗效果较差,因此手术是主要的治疗手段[1,2].手术治疗能迅速改善患者的症状,但是由于老年退行性腰椎管狭窄症多存在脊柱不稳定,甚至存在退变性滑脱,传统手术并不能解决所有问题[3].     

重度氟骨症腰椎管狭窄症及手术治疗

我科1987年以来,治疗氟骨症患者120例,确诊为重度氟骨症腰椎管狭窄者40例,30例接受了椎板切除减压手术治疗,均收到了较满意的效果,报告如下。     

微创与开放经椎间孔椎间融合术治疗腰椎滑脱症的临床对比研究

［摘要］　目的　对比Mast Quadrant微创系统下经椎间孔椎间融合术（Mini-TLIF）与传统开放经椎间孔椎间融合术（Open-TLIF）治疗腰椎滑脱症的临床疗效。方法　回顾分析40例单节段腰椎滑脱症患者,Quadrant后路微创撑开系统辅助下行经椎间孔椎间融合术20例为微创组,开放腰椎后路经椎间孔椎间融合术20例为开放组。收集患者围手术期的资料,包括切口长度、术中出血量、引流量、手术时间和术后下床活动时间等。对所有患者术前、术后2周、2个月、1年、2年进行VAS及ODI评分并记录。比较微创组与开放组患者之间的疗效。结果　微创组在切口长度、出血量、术后下床活动时间等方面优于开放组,差异有统计学意义（P<0.01）;但微创组手术时间长于开放组（P<0.05）。两组患者术后VAS、ODI评分均呈下降趋势,术后各时点评分与术前比较差异均具有统计学意义（P<0.01）。微创组术后VAS、ODI评分下降幅度较开放组下降幅度大,差异具有统计学意义（P<0.01）。术后2周VAS、ODI评分,微创组优于开放组（P<0.01）。结论　Mast Quadrant微创系统下经椎间孔椎间融合术与开放腰椎后路经椎间孔椎间融合术比较,具有切口小、术中及术后出血量少、术后下床活动时间早、短期临床疗效显著等优点。只要严格掌握手术适应证,该项微创技术值得临床推广。     

对全椎板切除治疗腰椎管狭窄症的术后疗效评价

对５８例腰椎管狭窄症患者行全椎板切除术。术后随访４－１０年，９例存在持续腰痛，２例椎向前滑移，６便推板再生，８例骨质增生加剧。认为广泛椎板切除是术后持续腰痛的主要原因，椎板再生可致椎管再度狭窄。     

全椎板切除减压和脊柱内固定术在退行性腰椎管狭窄症治疗中的应用

退行性腰椎管狭窄症是指由于椎间盘、关节突等脊柱结构退变老化而导致的椎管狭窄〔1～5〕,它在中老年人中发病率较高,是中老年腰腿痛最常见的原因〔6〕。其典型症状是神经性间歇跛行〔7〕,即在行走时下肢后侧或后外侧出现麻木、疼痛,休息片刻后症状会得到缓解〔8〕,如果再走又会疼〔9〕。所以中老年     

老年人腰椎管狭窄症的临床特点及手术治疗

目的探讨老年人退行性腰椎管狭窄症的临床特点和手术效果。方法回顾性分析42例老年人退行性腰椎管狭窄症的临床资料。结果老年人退行性腰椎管狭窄的特征为腰椎多节段退变,起病缓慢,间歇性跛行是最长伴有的症状,直腿抬高试验阳性率低,中央椎管和神经根管都有不同程度的狭窄,突出较少的椎间盘就能压迫硬膜囊或神经根而产生疼痛,所有患者的手术均安全完成。平均随访2.1年,根据JOA评分系统,将手术前后JOA评分比较,差异有统计学意义(P0.05)。结论老年人退行性腰椎管狭窄症患者合并内科疾病多,较长的病程,症状多体征少,多节段退变,积极治疗内科并发症,根据症状、体征、影像学,给予责任节段充分减压及固定融合责任节段,能获得较好手术疗效。     

An open study of pamidronate in the treatment of refractory degenerative lumbar spinal stenosis

Degenerative lumbar spinal stenosis, manifesting as chronic low back pain and neurogenic claudication, is an increasing chronic problem in an aging population, with limited effective conservative treatment options. Based on previous reports on the utility of subcutaneous calcitonin and two anectodal cases, we launched an open therapeutic trial of IV monthly pamidronate infusions, over a course of 3–6 months in this condition. Of 24 patients, 75% reported pain improvement, with the mean VAS score improved by 40%; while composite functional improvement in walking time, activities of daily living, and sense of well being was reported by 66%, with a mean improvement of 50%. The results of this pilot trial suggest the usefulness of this modality and warrant examination in a controlled clinical trial.     

椎管内扩大成形术治疗腰椎管狭窄症的临床疗效

目的探讨椎管内扩大成形术(EICP)治疗老年性中央型腰椎管狭窄的早期疗效及优势。方法回顾性地分析空军总医院2015年1月至2015年7月采用EICP治疗以间歇性跛行为主要表现的退行性中央型椎管狭窄患者23例。观察手术时间、术中出血量、术中神经脊髓监测情况、术后引流量、手术并发症情况,术后影像学观察腰椎管横截面积和腰椎融合情况,采用日本骨科联合会(JOA)评分、Oswestry失能指数(ODI)评分、间歇性跛行的改善情况评价临床效果。结果本组所有病例均获得随访,随访时间12~16(13.8±1.5)个月,单节段术中出血量(257.5±47.1)m1,手术时间(114.5±16.8)min,术后引流量(150.0±37.6)m1。双节段术中出血量(344.5±55.6)ml,手术时间(161.8±24.4)min,术后引流量(225.4±40.1)ml,术中脊髓神经监测均未见持续异常。3例患者发生并发症,1例术中出现硬膜囊撕裂,对症处理后术后5 d脑脊液停止,2例术后出现切口延期愈合,积极给予换药,术后3周愈合良好。术前、术后1周CT扫描手术目标狭窄节段水平椎管横截面积,术前L3-4(73.32±2.67)mm~2、L4-5(116.24±2.17)mm~2,术后L3-4(213.33±3.26)mm~2、L4-5(260.16±3.67)mm~2,术前术后差异均有统计学意义(P0.05)。术后1年随访时JOA评分、ODI评分及间歇性跛行的情况较术前明显改善,差异有统计学意义(P0.05)。根据JOA评分,术后平均改善率90.05%。术后3个月、6个月、1年融合率分别为78.2%、86.9%、95.6%。结论 EICP是对传统中央型腰椎管狭窄症的全椎板切除减压手术的革新,体现了精准外科和微创外科的现代外科理念,既能对狭窄的椎管行有效减压,又能保护腰椎后方的原生结构不受到破坏,维持腰椎稳定性,增大植骨面积、提高融合率,手术疗效确切,并发症发生率低,是一种治疗腰椎管狭窄症的有效方法。     

Comparison of the clinical efficacy of percutaneous transforaminal endoscopic discectomy and traditional laminectomy in the treatment of recurrent lumbar disc herniation

A few years ago, percutaneous transforaminal endoscopic discectomy (PTED) began to prevail in clinical treatment of recurrent lumbar disc herniation (RLDH), whereas traditional laminectomy (TL) was treated earlier in RLDH than PTED. This study aimed to compare the clinical efficacy of PTED and TL in the treatment of RLDH.Between November 2012 and October 2017, retrospective analysis of 48 patients with RLDH who were treated at the Cancer Hospital, Chinese Academy of Sciences, Hefei and Department of Orthopaedics, Second Affiliated Hospital of Anhui Medical University. Perioperative evaluation indicators included operation time, the intraoperative blood loss, length of incision and hospitalization time. Clinical outcomes were measured preoperatively, and at 1 days, 3 months, and 12 months postoperatively. The patients’ lower limb pain was evaluated using Oswestry disability index (ODI) and visual analog scale (VAS) scores. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. Every category comprises 6 options, with the highest score for each question being 5 points. higher scores represent more serious dysfunction. The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, which the other end is 10, which means severe pain, and the middle part indicates different degree of pain.Compared with the TL group, the operation time, postoperative bed-rest time, and hospitalization time of the PTED group were significantly shorter, and the intraoperative blood loss was also reduced. These differences were statistically significant (P < .01). There were no significant differences in VAS or ODI scores between the two groups before or after surgery (P > .05).PTED and TL have similar clinical efficacy in the treatment of RLDH, but PTED can shorten the operation time, postoperative bed-rest time and hospitalization time, and reduce intraoperative blood loss, so the PTED is a safe and effective surgical method for the treatment of RLDH than TL, but more randomized controlled trials are still required to further verify these conclusions.     

The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years

OBJECTIVES: To assess the relative effect of initial surgical and nonsurgical treatment on longitudinal outcomes of patients with lumbar spinal stenosis over a 10-year follow-up period. DESIGN: A prospective observational cohort study. SETTING: Enrollment from community-based specialist practices throughout Maine. PARTICIPANTS: One hundred forty-four patients with lumbar spinal stenosis who had at least one follow-up: 77 initially treated surgically and 67 initially treated nonsurgically. INTERVENTION: Initial surgical or nonsurgical treatment. MEASUREMENTS: Clinical data were obtained at baseline and outcomes followed at regular intervals over 10 years with mailed questionnaires including patient-reported symptoms of back pain, leg symptoms, back-specific functional status, and satisfaction. Longitudinal data were analyzed using general linear mixed models. In addition to treatment (initial surgical or nonsurgical care), time period, and the interaction between treatment and time, the models included baseline score, patient age and sex, and a time-varying general health status score. The effects of these covariates in explaining differences between treatment groups were also examined. The effect of subsequent surgical procedures was assessed using different analysis strategies. RESULTS: The 10-year rate of subsequent surgical procedures was 23% and 38% for patients initially treated surgically and nonsurgically, respectively, and the overall 10-year survival rate was 69%. Patients undergoing initial surgical treatment had worse baseline symptoms and functional status than those initially treated nonsurgically. For all outcomes and at each time point, surgically treated patients reported greater improvement in symptoms and functional status and higher satisfaction scores, indicative of better outcomes, than nonsurgically treated patients. However, the relative magnitude of the benefit diminished over time such that the relative differences for low back pain and satisfaction were no longer significant over long-term follow-up (both P=.08 for treatment effect between 5 and 10 years after controlling for covariates). Regardless of initial treatment received, patients undergoing subsequent surgical procedures reported less improvement in outcomes over time than patients who did not undergo subsequent procedures, but the relative differences between treatment groups were similar in analyses that controlled for outcomes after subsequent procedures. CONCLUSION: After controlling for covariates, patients initially treated surgically demonstrated better outcomes on all measures than those initially treated nonsurgically. Although outcomes of initial surgical treatment remained superior over time, the relative benefit of surgery diminished in later years, especially for low back pain and satisfaction. Patients undergoing subsequent surgery had worse outcomes regardless of initial treatment received, but excluding them did not change overall treatment group comparisons. The analytical methods described may be helpful in the design and analysis of future studies comparing treatment outcomes for patients with lumbar spinal stenosis.     

Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: A clinical and radiographic study

Retrospective cohort study.Full-endoscopic decompression of lumbar spinal canal stenosis is being performed by endoscopic surgeons as an alternative to micro-lumbar decompression in the recent years. The outcomes of the procedure are reported by few authors only. The aim of this paper is to report the clinical and radiographic outcomes of full endoscopic lumbar decompression of central canal stenosis by outside-in technique at 1-year follow-up.We reviewed patients operated for lumbar central canal stenosis by full endoscopic decompression from May 2018 to November 2018. We analyzed the visual analogue scale scores for back and leg pain and Oswestry disability index at pre-op, post-op, and 1-year follow-up. At the same periods, we also evaluated disc height, segmental lordosis, whole lumbar lordosis on standing X-rays and canal cross sectional area at the affected level and at the adjacent levels on magnetic resonance imaging and the facet length and facet cross-sectional area on computed tomography scans. The degree of stenosis was judged by Schizas grading and the outcome at final follow-up was evaluated by MacNab criteria.We analyzed 32 patients with 43 levels (M:F = 14:18) with an average age of 63 (±11) years. The visual analogue scale back and leg improved from 5.4 (±1.3) and 7.8 (±2.3) to 1.6 (±0.5) and 1.4 (±1.2), respectively, and Oswestry disability index improved from 58.9 (±11.2) to 28 (±5.4) at 1-year follow-up. The average operative time per level was 50 (±16.2) minutes. The canal cross sectional area, on magnetic resonance imaging, improved from 85.78 mm² (±28.45) to 150.5 mm² (±38.66). The lumbar lordosis and segmental lordosis also improved significantly. The disc height was maintained in the postoperative period. All the radiographic improvements were maintained at 1-year follow-up. The MacNab criteria was excellent in 18 (56%), good in 11 (34%), and fair in 3 (9%) patients. None of the patients required conversion to open surgery or a revision surgery at follow-up. There was 1 patient with dural tear that was sealed with fibrin sealant patch endoscopically. There were 10 patients who had grade I stable listhesis preoperatively that did not progress at follow-up. No other complications like infection, hematoma formations etc. were observed in any patient.Full endoscopic outside-in decompression method is a safe and effective option for lumbar central canal stenosis with advantages of minimal invasive technique.     

Evaluation on curative effects of percutaneous endoscopic lumbar discectomy via a transforaminal approach versus an interlaminar approach for patients with lumbar disc herniation: A protocol for systematic review and meta-analysis

Background:The present meta-analysis aims to conduct a systematic comparative study of the curative effects of Percutaneous Endoscopic Transforaminal Discectomy (PETD) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) when used to treat Lumbar Disc Herniation (LDH).Methods:The following online databases will be searched to find articles related to treating of LDH using PETD and PEID, namely PubMed, EMBASE, Cochrane databases, China National Knowledge Infrastructure, WanFang Database, and Web of Science. The search will include all articles published from inception until August 2021. Articles will be included according to the inclusion criteria. Two authors will independently screen and assess the quality of each study. RevMan (version 5.3) will be adopted to complete data analysis and evaluate the statistical significance of each operating technique in various outcomes.Results:The present meta-analysis will evaluate the curative effects of using PETD and PEID to treat LDH patients.Conclusion:Compare the clinical efficiency of PETD and PEID as therapy for LDH with postoperative hypoesthesia, complications in surgical site wounds, nerve root injury, transfer to open surgery, recurrence, partial decompression, and other complications. The comparative analysis will help determine the difference between the 2 surgical methods of PETD and PEID for treating LDH.OSF registration number:August 2, 2021.osf.io/hr964. (https://osf.io/hr964/)     

老年人腰椎管狭窄症的手术治疗46例分析

目的观察新术式多节段椎板开窗、椎管潜行式扩大减压成形术治疗老年人腰椎管狭窄症的疗效，并评价其优缺点。方法采用该术式治疗老年人腰椎管狭窄症４６例，其中退行性２９例，混合性１３例，发育性４例；有３例Ⅰ°腰椎滑脱。结果平均手术时间１个半小时，失血量２２０ｍｌ，平均术后３天下床功能煅练。手术并发症共３例，２例硬脊膜撕裂和１例神经根损伤。４６例随访时间１２～４４个月，平均２５个月。优１９例（４１．３％），良２１例（４５．７％），可６例（１３％），术后无症状加重和病情恶化者。结论结果表明本术式是治疗老年人腰椎管狭窄的一种安全和有效的方法。     

Effectiveness and safety of acupotomy on lumbar spinal stenosis: A pragmatic randomized,controlled, pilot clinical trial: A study protocol

Introduction:Lumbar spinal stenosis (LSS) is a pathological condition that causes a variety of neurological symptoms due to narrowing of the anatomical structures; usually, conservative treatment is recommended, rather than surgical treatment. Acupotomy combines conventional acupuncture with small scalpels; the procedure can be considered minimally invasive, and has recently received considerable attention in clinical practice. Still, there is a lack of data and randomized controlled trials regarding acupotomy related to LSS. Additional studies are necessary, considering the low methodological quality and small size of the study.Methods and analysis:This is a pragmatic, pilot, randomized controlled trial. The trial comprises 8 weeks of treatment, with 16 visits and a 4-week follow-up period. Forty participants diagnosed with LSS will be randomly assigned to either the experimental or control groups; both groups will receive acupuncture and interferential current therapy twice a week for 8 weeks, while the experimental group will receive an additional acupotomy intervention once a week for 8 weeks. The primary outcome will be assessed using the visual analog scale; the secondary outcome will be measured by self-rated walking distance, Oswestry Disability Index, and short-form McGill Pain Questionnaire. Measurements will be obtained prior to the start of the clinical trial, 4 weeks after the interventional procedure, 8 weeks after the procedure, and 4 weeks after the end of the interventional procedure. Blood tests and adverse reactions will be performed to ensure safety of the treatments.Conclusion:We expect that this study will provide basic data for future large-scale acupotomy studies regarding LSS.     

Comparison of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for upper lumbar disc herniation: A protocol for a systematic review and meta-analysis

Background:Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery (MISS), are widely conducted in the treatment of upper lumbar disc herniation (ULDH). This study will systematically assess and compare the clinical outcomes of MED and PTED in treating ULDH combining with the meta-analysis.Methods:All the randomized controlled trials (RCTs) will be searched at the databases including PubMed, EMBASE, Cochrane Library and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and WANFANG Database from inception to December 2025. The primary outcome will involve Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and visual analog scale (VAS) scores. The secondary outcomes will be the short-form 36-item (SF-36) health survey questionnaire and the modified MacNab criterion. We will perform data synthesis, subgroup analysis, sensitivity analysis, meta-regression analysis, and the assessment of reporting bias using RevMan 5.3 software.Results:This systematic review will comprehensively evaluate the clinical outcomes of comparison of MED and PTED in the treatment of ULDH and provide a reliable and high-quality evidence.Conclusion:The conclusion of this study will elucidate the clinical outcomes of MED compared with PTED and clarify whether PTED generates better clinical effects than MED in treating ULDH.PROSPERO registration number:CRD 42021244204