P26。后路减压联合常规经椎间孔腰椎椎体间融合术（TLIF）与全内镜椎间孔成形术治疗稳定腰椎椎间孔狭窄的比较结果：回顾性队列研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100650

Sarun Pairuchvej MD

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引用次数: 0

摘要

背景：腰椎椎间孔狭窄是指退行性腰椎疾病中脊神经被困在狭窄的腰椎孔内。这种情况的金标准治疗尚未提出。已有几种不同的治疗方法，包括椎间孔切开术、椎面切开术、部分椎弓根切除术、融合术和撑开内固定术。如今，由于内窥镜技术的巨大进步，将内窥镜减压的指征从中央椎管扩展到椎间孔外区，这是单纯显微镜难以获得的。目的比较后路减压联合传统经椎间孔腰椎椎体间融合术（TLIF）和全内窥镜椎间孔成形术（FELF）治疗稳定性腰椎椎间孔狭窄的疗效。研究设计/背景：这是一项于2019年1月至2024年1月在泰国Savang皇后纪念医院进行的回顾性研究。患者SAMPLEA：泰国萨旺皇后纪念医院共60例患者表现为稳定性腰椎椎间孔狭窄。将患者分为后路减压联合常规经椎间孔腰椎椎间融合术（TLIF）组（N=30）和全内窥镜腰椎椎间孔成形术（FELF）组（N=30）。结果：统计数据和围手术期参数分析。分别于术前、术后第1天、第2周、第3个月、第6个月和第1年记录视觉模拟评分（VAS）和Oswestry残疾指数（ODI）。其他参数如估计失血量（EBL）、住院时间和手术并发症也被记录。方法TLIF组采用标准操作。后路减压，椎弓根螺钉和椎间保持器（Mont blanc, Spineway, France）在图像增强器（BV Pulsera, Philips）下置入。对于内窥镜椎间孔成形术，采用单门静脉狭窄镜（椎体，Riwospine）进行内窥镜减压手术。结果TLIF组与FELF组患者6个月VAS评分（P=0.347）、1年VAS评分（P= 0.286）、3个月ODI评分（P=0.868）、6个月ODI评分（P=0.169）、1年ODI评分（P= 0.195）差异无统计学意义。相反，FELF组术后早期VAS (VAS at d1 (P<；0.001)和3个月VAS (P=0.001)，住院时间(P<；0.01)和出血量(P<；0.001)。两组患者均无严重并发症。TLIF组出现硬膜撕裂（N=2）， FELF组无。术后出现神经痛5例（TLIF=2， FELF=3），术后1 ~ 2个月完全恢复。没有检测到与硬件相关的并发症。结论：与标准TLIF相比，sfelf是一种有效、安全、微创的治疗稳定腰椎椎间孔狭窄的方法，其疗效可达1年。FDA器械/药物状态批准用于此适应症。

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P26. Comparative outcomes of posterior decompression with conventional transforaminal lumbar interbody fusion (TLIF) versus full endoscopic foraminoplasty in stable lumbar foraminal stenosis: retrospective cohort study

BACKGROUND CONTEXT

Lumbar foraminal stenosis is a condition in which a spinal nerve is entrapped in a narrow lumbar foramen in degenerative lumbar spinal disorders. The gold standard treatment of this condition had not been proposed yet. Several different techniques for this problem has been described, including foraminotomy, facetectomy, partial pediculectomy, fusion, and distraction instrumentation. Nowadays, due to the great advancement of the technology in endoscopy expanded the indication of endoscopic decompression from the central canal to the extraforaminal zone, which was difficult to gain access from mere microscope.

PURPOSE

To compare outcomes between posterior decompression With conventional transforaminal lumbar interbody fusion (TLIF) and full-endoscopic foraminoplasty (FELF) in stable lumbar foraminal Stenosis

STUDY DESIGN/SETTING

This is a retrospective study conducted from Jan 2019-Jan 2024 in Queen Savang Vadhana Memorial Hospital, Thailand.

PATIENT SAMPLE

A total of 60 patients presented with stable lumbar foraminal stenosis in Queen Savang Vadhana Memorial Hospital Thailand. They were divided into posterior decompression with conventional transforaminal lumbar interbody fusion (TLIF) group (N=30) and full-endoscopic lumbar foraminoplasty (FELF) group (N=30).

OUTCOME MEASURES

Demographic data and pre-perioperative parameters were analyzed. Post-operative outcome, for instance, Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) were recorded at preoperative, post-op day 1, 2 weeks, 3 month, 6 month and 1 year, respectively. Other parameters such as estimated blood loss (EBL), length of hospital stay and operative complications were also recorded.

METHODS

For TLIF group, Standard procedure had been performed. Posterior decompression, pedicle screws and interbody cage (Mont blanc, Spineway, France) insertion under image intensifier (BV Pulsera, Philips). For endoscopic foraminoplasty, uniportal stenoscope (Vertebris, Riwospine) was used to perform endoscopic decompressive surgery.

RESULTS

The TLIF group and FELF group revealed no statistical difference in terms of VAS at 6month (P=0.347), VAs at 1 year (p=0.286), ODI at 3-month (P=0.868), ODI at 6 month (P=0.169) and ODI at 1 year (p=0.195). In contrary, the FELF group had better early post-operative VAS (VAS at d1 (P< 0.001) and VAS at 3-month (P=0.001)), length of hospital stay (P< 0.01) and blood loss (P< 0.001). There were no serious complications in both groups. Dural tear were found in TLIF (N=2) and none in FELF. Post-op neuralgia were detected in 5 cases (TLIF=2, FELF=3), which were fully recovered in 1-2 months. No complications related to hardware detected.

CONCLUSIONS

FELF is an effective, safe and less invasive procedure for stable lumbar foraminal stenosis compared to standard TLIF which yielded comparable outcome up to 1 year.