Early efficacy of endoscopic laminectomy and traditional hemilaminectomy for lumbar spinal stenosis
10.3760/cma.j.issn.0253-2352.2019.12.005
- VernacularTitle: 经皮内镜下椎板减压术与开放半椎板减压术治疗腰椎管狭窄症的疗效比较
- Author:
Fenglong SUN
1
;
Qingchen LIANG
1
;
Hongqing WANG
1
;
Zuyao LIU
1
;
Fu LI
1
;
Jie DONG
1
;
Wenbo DIAO
2
;
Ming YAN
3
;
Yongcheng HU
4
Author Information
1. No. 2 Department of Orthopaedics, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing 100144, China
2. Department of Orthopaedics, Zhoukou Union Osteological Hospital, Zhoukou 466000, China
3. Department of Spinal Surgery, First Hospital of Bethune, Jilin University, Changchun 130021, China
4. Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin 300210, China
- Publication Type:Clinical Trail
- Keywords:
Lumbar vertebrae;
Spinal stenosis;
Laminectomy;
Video-assisted surgery;
Surgical procedures, minimally in-vasive
- From:
Chinese Journal of Orthopaedics
2019;39(12):755-765
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of endoscopic laminectomy with traditional hemilaminectomy for lumbar spinal stenosis.
Methods:From January 2016 to April 2017, 61 patients with lumbar spinal stenosis were treated surgi-cally. Percutaneous endoscopic laminectomy was performed in 32 patients (minimally invasive group), including 13 males and 19 females, aged 38-76 years, with an average age of 58.47±7.51 years. Twenty-nine patients (open group) underwent hemilaminecto-my, including 11 males and 18 females, aged 38-75 years, with an average age of 57.17±9.99 years. The operation time, bleeding, incision length, bedridden time and hospitalization time were recorded. Visual analogue scale(VAS), Oswestry disability index (ODI), dural sac cross-sectional area (DSCA), ventral intervertebral space height (VH), dorsal intervertebral space height (DH) and lumbar mobility (range of motion, ROM) were compared between the two groups.
Results:All of 61 patients were followed up for 14 to 27 months, with an average of 19.2±2.95 months. The operation time was 60.88±6.49 min in the minimally invasive group, and 52.07±9.45 min in the open group (t=4.277, P=0.000). The blood loss of minimally invasive group was 55.63±10.14 ml, and that of open group was 78.79±12.58 ml (t=7.952, P=0.000). The incision length of minimally invasive group was 23.31±4.56 mm, and open group 82.59±7.66 mm (t=12.047, P=0.000). Bed rest time was 21.97±6.42 h in minimally invasive group and 78.79±12.58 h in open group (t=12.047, P=0.000). The hospitalization time of the minimally invasive group was 8.53±2.75 d and the open group 11.34±3.12 d (t=3.745, P=0.000). All these parameters had statistical significance (P<0.05). At the last follow-up, the VAS score of minimally invasive group was 1.06±0.56, and the open group was 1.14±0.74 (t=0.469, P=0.634). ROM of open group was 5.66±1.12 degree, and ROM of minimally invasive group was 5.56±1.13 degree (t=0.140, P=0.710), VH of minimally invasive group was 14.75±2.81 mm, and open group was 14.44±2.89 mm (t=0.181, P=0.672). There was no significant difference between the two groups for these parameters. At the last follow-up, ODI score was 13.25%±1.08% in the minimally invasive group and 14.28%±2.10% in open group (t=5.911, P=0.018). DSCA score was 108.56±8.69 mm2 in the minimally invasive group, and 117.28±11.09 mm2 in open group (t=11.774, P=0.001). There were significant differences between the two groups for ODI and DS-CA.
Conclusion:Both endoscopic and open laminectomy have excellent clinical effects on lumbar spinal stenosis. Endoscop-ic laminectomy has the advantages of less local trauma, less damage to the stability of the lumbar spine and faster recovery. However, there's a higher technical requirement for endoscopic spine surgery.
