Percutaneous endoscopic decompression of responsible segments for the treatment of multi-segmental lumbar degenerative diseases
JI Xiang1, DU Mingkui1,2, ZHONG Weitao1, JIN Kaifeng1, CHEN Xuanyu1, ZHAO Hui1, ZHANG Zhenhua1, ZHANG Liming1
1. Second Department of Orthopedics,Electric Power Teaching Hospital of Capital Medical University, Beijing 100073, China; 2. Third Department of Orthopedics,the Third Medical Center of the PLA General Hospital,Beijing 100039,China
Abstract：Objective To investigate the diagnosis of the responsible segment and the effectiveness of percutaneous endoscopic decompression against multi-segmental lumbar degenerative diseases. Methods Fifty-three cases of multi-segmental lumbar degenerative diseases treated between January 2015 and December 2018 were retrospectively analyzed. The responsible segments of all the patients were identified using one of the two methods. The first method involved analysis of the symptoms,signs and images to detect the responsible segment that resulted in low back or leg pain. The second involved using the selective nerve root block(SNRB) to identify the responsible segment before operation. All the patients with clearly-defined responsible segments were then treated with percutaneous endoscopic decompression. The duration of surgery,intraoperative blood loss,and complications were recorded. The clinical outcome was evaluated according to the visual analogue scale (VAS),the Oswestry disability index (ODI),and the modified MacNab criterion. Results The responsible segments of twenty-one of the patients were identified with the first method. The rest received SNRB,but two of these cases did not have their responsibility segments specified,so they were not included in the study. The diagnostic accuracy was confirmed during the decompression of the patients. All the fifty-one patients whose responsible segments were clearly determined underwent percutaneous endoscopic decompression and the mean duration of surgery was 76.8 (58-150 ) minutes .There were no such complications as nerve injury,hematoma,incision infection,dural tear,or lumbar instability. All the patients were followed up for an average of 18.3 (12-47) months. The VAS and ODI at 7 days,3 months,6 months,and l2 months after operation were significantly improved (P<0.01). According to the modified MacNab criterion,there were twenty-one excellent cases,twenty-three good cases,five fair cases and two poor cases . The rate of excellent and good cases was 86.3%. Conclusions SNRB, when used to identify the responsible segment for multi-segmental lumbar degenerative diseases before operation, is user-friendly and reliable. Percutaneous endoscopic decompression against multi-segmental lumbar degenerative diseases is safe,minimally invasive and effective.
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2021, Vol. 32 
