经皮内镜下责任节段减压治疗多节段腰椎退变疾病的效果

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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.

Key words： multi-segmental lumbar degenerative diseases responsible segment selective nerve root block minimally invasive percutaneous endoscopic decompression

Received: 05 February 2021

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	Articles by authors
	JI Xiang
	DU Mingkui
	ZHONG Weitao
	JIN Kaifeng
	CHEN Xuanyu
	ZHAO Hui
	ZHANG Zhenhua
	ZHANG Liming

Cite this article:

JI Xiang,DU Mingkui,ZHONG Weitao等. Percutaneous endoscopic decompression of responsible segments for the treatment of multi-segmental lumbar degenerative diseases[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(7): 577-581.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2021/V32/I7/577

[1]	Costandi S,Chopko B,Mekhail M,et al. Lumbar spinal stenosis: therapeutic options review [J]. Pain Pract,2015,15(1):68-81.
[2]	Kovacs F M,Urrutia G,Alarcon J D. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials[J]. Spine,2011,36(20):E1335-1351.
[3]	Alimi M,Hofstetter C P,Pyo S Y,et al. Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates[J]. J Neurosurg Spine,2015,22(4): 339-352.
[4]	王超锋,张超,何勍,等.选择性神经根封闭术在有限手术治疗多节段腰椎退行性疾病中的作用[J].中国骨与关节杂志,2019,8(3): 209-215.
[5]	Vroomen P C,de Krom M C,Wilmink J T,et al. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression[J]. J Neurol Neurosurg Psychiatry,2002,72(5): 630-634.
[6]	Germon T,Singleton W,Hobart J. Is nice guidance for identifying lumbar nerve root compression misguided? [J]. Eur Spine J,2014,23(Suppl 1): S20-S24.
[7]	Li X C,Bai X D,Wu Y H,et al. A valid model for predicting responsible nerve roots in lumbar degenerative disease with diagnostic doubt[J]. BMC Musculoskelet Disord,2016,17: 128.
[8]	Kleinstueck F S,Fekete T F,Jeszenszky D,et al. Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments [J]. Eur Spine J,2016,25(8): 2649-2656.
[9]	Liang Y,Zhao Y F,Wang T H,et al. Precision treatment of adult lumbar degenerative scoliosis complicated by lumbar stenosis with the use of selective nerve root block[J]. World Neurosurgery,2018,120(9): e970-975.
[10]	张斌,孔清泉,杨进,等.经皮内镜下经椎间孔入路双侧减压治疗重度腰椎中央管狭窄症近期疗效[J].中国修复重建外科杂志,2019,33(11):1399-1405.
[11]	Yeung A,Roberts A,Zhu L F,et al. Treatment of soft tissue and bony spinal stenosis by a visualized endoscopic transforaminal technique under local anesthesia[J]. Neurospine,2019,16(1):52-62.
[12]	辛志军,蔡梦涵,季文军,等.后路经皮全内镜技术单侧入路双侧减压治疗腰椎管狭窄症[J].中国修复重建外科杂志,2019,33(7):822-830.
[13]	Abed E I,Barakat M,Ainscow D. Multilevel lumbar spinal stenosis decompression: midterm outcome using a modified hinge osteotomy technique[J]. J Spinal Disord Tech,2011,24(6): 376-380.
[14]	胡强,杨小龙,于鑫,等.选择性神经根封闭术在多节段腰椎疾病定位诊断及有限手术中的应用[J].中国骨与关节损伤杂志,2017,32(5):475-478.
[15]	惠正广,张镇,刘诗荣,等.责任节段减压固定融合治疗老年人多节段退行性腰椎管狭窄的效果分析[J].中华骨与关节外科杂志,2015,8(6):486-490.
[16]	Datta S,Manchikanti L,Falco J E,et al. Diagnostic utility of selective nerve root blocks in the diagnosis of lumbosacral radicular pain: systematic review and update of current evidence[J]. Pain Physician,2013,16(2 suppl): SE97-SE124.
[17]	Xia X PChen H L,Cheng H B. Prevalence of adjacent segment degenerationafter spine surgery:a systematic review and meta-analysis [J]. Spine(Phila Pa 1976),2013,38(7):597-608.
[18]	杜明奎,管大伟,匡正达,等.经皮椎间孔镜技术治疗腰椎间盘突出症[J].中国骨与关节损伤杂志, 2018,33(1): 58-59.
[19]	李振宙,侯树勋,吴闻文,等.经皮侧后路椎间孔成型术对腰椎解剖及生物力学影响的实验研究[J].中国骨肿瘤骨病,2010,9(6): 503-508.
[20]	Lee C W,Yoon K J,Kim S W. Percutaneous endoscopic decompression in lumbar canal and lateral recess stenosis.the surgical learning curve [J]. Neurospine,2019,16(1): 63-71.