经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病

目的讨论经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病的临床疗效。 方法回顾性收集2015年1月至2016年8月山东省文登整骨医院脊柱脊髓科收治的老年腰椎融合术后出现邻椎病的患者34例，男性25例，女性9例，年龄61~81岁，平均年龄（66±7）岁。全部患者采用经皮椎间孔入路内镜减压手术。记录手术时间及术中应注意的事项。在术前、术后1、6、12个月及末次随访时，按MacNab标准进行临床疗效的评价，进行腰部及下肢的疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）；在6个月随访时，行腰椎MRI检查评估神经根减压状况，并进行腰椎正侧位、动力位片评价本次手术节段的稳定性。 结果34例患者均顺利完成手术，随访时间为24~44个月，平均（32±7）个月。手术时间54~142 min，平均（68±30）min。重复测量的方差分析显示，术后1、6、12个月、末次随访时，ODI较术前明显下降，差异具有统计学意义（F=2008.780，P<0.001）；腰痛VAS评分较术前明显下降，差异具有统计学意义（F=599.821，P<0.001）；下肢痛VAS评分较术前明显下降，差异具有统计学意义（F=601.751，P<0.001）；6个月随访时，改良MacNab标准评估：优27例、良5例、可2例，优良率为94.12%。1例出现置管过程中导丝断裂；1例出现出口神经根外膜的撕裂；1例患者出现出口根刺激症状。末次随访时，3例椎间失稳。未发生神经根及硬膜囊的损伤，未发生手术节段错误。 结论经皮椎间孔入路内镜治疗老年人腰椎融合术后邻椎病，创伤小，临床疗效好。

Percutaneus endoscopic transforaminal approach decompression accurately for adjacent segmental disease after lumbar fusion

ObjectiveTo discuss the effect of treatment and the matters needing attention during the operation Through percutaneous transforaminal endoscopic surgery for Adjacent segmental disease after lumbar fusion. MethodsFrom January 2015 to August 2016, 34 elderly patients (25 males and 9 females) with adjacent vertebral diseases occurred after lumbar fusion. The age ranged from 61 to 81 years, with an average of (66±7) years. All patients underwent percutaneous endoscopic decompression via transforaminal approach. Record the time of operation and the matters needing attention during the operation. In the preoperative and postoperative 1, 6, 12 months and the last follow-up, the clinical efficacy was evaluated according to the MacNab standard, the visual analogue score of the pain of the waist and lower limbs (VAS) and the Oswestry dysfunction index (ODI) were performed. During the follow-up of 6 months, lumbar MRI was performed to evaluate the status of nerve root decompression, and the stability of the operation was evaluated by anteroposterior and lateral lumbar radiographs and dynamic radiographs. ResultsThe operation time was successfully completed in all 34 patients. The time of operation was 54-142 min, with an average of (68±30) min. The follow-up time was 24-44 months, with an average of (32±7) months. The scores of ODI at 1, 6, 12 months and final follow-up were significantly lower than those before operation (F=2008.780, P<0.001); The scores of Low back pain VAS at 1, 6, 12 months and final follow-up were significantly lower than those before operation (F=599.821, P<0.001); The scores of Lower limb pain VAS at 1, 6,12 months and final follow-up were significantly lower than those before operation (F=601.751, P<0.001). At the time of follow up in June, the modified MacNab criteria assessed excellent outcomes in 27 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 94.12%.One case had rupture of the guide wire, one case had tear of the epineurium of the outlet nerve root, and one case had irritation of the outlet root. At the last follow-up, 3 cases of intervertebral instability were found. No nerve root and dural sac injury occurred, no operative segment errors occurred. ConclusionPercutaneous intervertebral foramen endoscopic treatment of adjacent vertebral disease in elderly patients after lumbar fusion has less trauma and good clinical effect.