Transforaminal Full-Endoscopic Ventral Facetectomy: Midterm Results and Factors Associated with Poor Surgical Outcomes
Transforaminal Full-Endoscopic Ventral Facetectomy: Midterm Results and Factors Associated with Poor Surgical Outcomes
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经椎间孔全内窥镜腹侧小关节切除术：中期结果和与手术效果不佳相关的因素
DOI：
10.1055/a-1995-1772
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Sairyo Koichi
中科院分区：
文献类型：
--
作者：
Kishima Kazuya;Yagi Kiyoshi;Yamashita Kazuta;Tezuka Fumitake;Morimoto Masatoshi;Takata Yoichiro;Sakai Toshinori;Maeda Toru;Sairyo Koichi
背景全内窥镜脊柱手术（FESS）是治疗髓核突出的成熟手术。这是一种微创手术，只需在局部麻醉下通过 8 毫米的皮肤切口即可进行。随着高速钻等手术设备的改进，FESS 的适应症已扩大到包括腰椎管狭窄症 (LSS)。我们在局部麻醉下采用经椎间孔入路对单侧神经根型侧隐窝狭窄 (LRS) 进行经椎间孔全内窥镜腹侧小关节切除术 (TF-FEVF)。本研究的目的是检查 TF-FEVF 治疗 LRS 的术后结果，并确定与手术效果不佳相关的因素。 85 名患者在局部麻醉下接受 TF-FEVF 治疗 LRS。临床结果通过视觉模拟量表 (VAS) 和修改后的 MacNab 标准来确定。使用磁共振成像 (MRI)、计算机断层扫描 (CT) 和屈伸 X 光片进行评估。方法本研究涉及 85 名接受 TF-FEVF 治疗 LRS 的患者（47 名男性和 38 名女性）。平均年龄为 70.5 岁，平均随访时间为 14.8 个月。收集性别、年龄、手术级别、诊断、同级别脊柱手术史以及随访时间等数据。诊断被归类为伴有或不伴有椎间盘突出的 LSS。使用 VAS 和修改后的 MacNab 标准进行临床评估。采用MRI评估椎间盘退变程度、椎体终板退变程度、椎间盘高度、黄韧带增厚及狭窄情况。使用 CT 评估骨狭窄。矢状平移和矢状角度也通过屈曲-伸展射线照片测量，科布角使用站立前视射线照片测量。使用改良的 MacNab 标准对具有优良/良好结果的患者（E/G 组）和具有一般/不良结果的患者（F/P 组）之间的所有变量进行比较。 结果术后 VAS 显示腿部疼痛从术前的 59.0±28.6 降至最终随访时的 17.9±27.2（p<0.01），腰痛也从术前为 60.7±26.6，最终随访时为 27.3±28.6（p<0.01）。根据改良MacNab标准，末次随访结果优39例，良21例，可13例，差12例。 E/G组60例（70.6%）与F/P组25例（29.4%）在性别、年龄、诊断、脊柱手术史、随访时间等方面无显着差异。影像学评估显示E/G组和F/P组在椎间角屈曲（3.2 vs. 0.4°；p< 0.05）、矢状角（4.3 vs. 8.1°；p< 0.05）、屈曲滑移（0.9 vs. 2.8°mm；p< 0.05）、矢状平移（0.7 vs. 1.6 mm；p< 0.05）和Cobb角（-0.5 vs. -1.9 °；p< 0.05）。结论 TF-FEVF中期结果总体良好；导致 TF-FEVF 结果良好或不良的因素是大矢状角、大矢状平移和凹侧。
BackgroundFull-endoscopic spine surgery (FESS) is a well-established procedure for herniated nucleus pulposus. It is a minimally invasive surgery that can be performed under local anesthesia through only an 8-mm skin incision. With improvements in surgical equipment such as high-speed drills, the indications for FESS have expanded to include lumbar spinal stenosis (LSS). We perform a transforaminal full-endoscopic ventral facetectomy (TF-FEVF) for unilateral nerve root–type lateral recess stenosis (LRS) using a transforaminal approach under local anesthesia.The aim of this study was to examine the postoperative results of TF-FEVF for LRS and to identify factors associated with poor surgical outcomes. 85 patients who underwent TF-FEVF for LRS under local anesthesia. Clinical outcomes were determined by visual analog scale (VAS) and the modified MacNab criteria. Evaluation was performed using magnetic resonance imaging (MRI), computed tomography (CT), and flexion–extension radiographs.MethodsThis study involved 85 patients (47 males and 38 females) who underwent TF-FEVF for LRS. The mean age was 70.5 years and the mean follow-up duration was 14.8 months. Data were collected on sex, age, level of operation, diagnosis, history of spine surgery at the same level, and duration of follow-up. The diagnosis was categorized as LSS with or without disk bulging. Clinical evaluation was performed using the VAS and modified MacNab criteria. MRI was used to evaluate the degree of disk degeneration, vertebral endplate degeneration, disk height, thickening of the ligamentum flavum, and stenosis. Bony stenosis was evaluated using CT. Sagittal translation and sagittal angulation were also measured by flexion–extension radiographs, and the Cobb angle was measured using a standing front view radiograph. All variables were compared between patients with excellent/good outcomes (E/G group) and those with fair/poor outcomes (F/P group) using the modified MacNab criteria.ResultsPostoperative VAS showed that leg pain decreased from 59.0 ± 28.6 preoperatively to 17.9 ± 27.2 at the final follow-up (p< 0.01) and that lower back pain also decreased from 60.7 ± 26.6 preoperatively to 27.3 ± 28.6 at final follow-up (p< 0.01). According to the modified MacNab criteria, the results during the final follow-up were excellent in 39 cases, good in 21 cases, fair in 13 cases, and poor in 12 cases. There were no significant differences in sex, age, diagnosis, history of spine surgery, and duration of follow-up periods between the 60 cases (70.6%) in the E/G group and the 25 cases (29.4%) in the F/P group. Imaging evaluation revealed statistically significant differences between the E/G group and the F/P group in intervertebral angle flexion (3.2 vs. 0.4 degrees;p< 0.05), sagittal angulation (4.3 vs. 8.1 degrees;p< 0.05), slip in flexion (0.9 vs. 2.8 mm;p< 0.05), sagittal translation (0.7 vs. 1.6 mm;p< 0.05), and Cobb angle (−0.5 vs. −1.9 degrees;p< 0.05).ConclusionMidterm results of TF-FEVF were generally favorable; factors contributing to good or poor TF-FEVF outcomes were large sagittal angulation, large sagittal translation, and concave side.
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椎管狭窄：病理生理学、临床和放射学分类。
DOI：
--
发表时间：
2005
期刊：
Instructional Course Lectures
影响因子：
--
作者：
E. Truumees
通讯作者：
E. Truumees
局麻下经椎间孔全内窥镜腰椎底切椎板切除术（TE-LUL）治疗腰椎中央管狭窄的新手术理念：病例报告和文献综述。
影响因子：
0.7
作者：
K. Sairyo;Kazuta Yamashita;H. Manabe;Y. Ishihama;K. Sugiura;Fumitake Tezuka;Y. Takata;T. Sakai;Yasuyuki Omichi;Nobutoshi Takamatsu;Ayaka Hashimoto;Toru Maeda
通讯作者：
Toru Maeda
影响因子：
2.4
作者：
CIRIC, I;MIKHAEL, MA
通讯作者：
MIKHAEL, MA
影响因子：
158.5
作者：
Weinstein, James N.;Tosteson, Tor D.;An, Howard
通讯作者：
An, Howard
影响因子：
1.7
作者：
Sairyo, Koichi;Nagamachi, Akihiro
通讯作者：
Nagamachi, Akihiro