Percutaneus endoscopic interlaminar decompression in degenerative lumbar spinal stenosis

English Keywords:Degenerative lumbar spinal stenosis  Microsurgery  Percutaneus endoscopic interlaminar  Laminotomy

English Abstract:

  【Abstract】 Objectives: To assess the clinical outcomes of percutaneus endoscopic interlaminar decompression in degenerative lumbar spinal stenosis(DLSS). Methods: From January 2014 to December 2014, 126 patients with DLSS accepted percutaneus endoscopic interlaminar decompression, including 82 males and 44 females aged from 46-83 years old(average, 65.8±12.4 years). There were 73 patients with stenosis in L4-5 and 53 patients with stenosis in L5-S1. Visual analogue score(VAS), Oswestry disability index(ODI) and modified MacNab were applied to evaluate clinical outcomes before surgery and at the follow-ups. Results: All of the 126 operations had been completed successfully with operation time of 48-75min(61.4±11.4min), 2-4 times(2.4±0.3 times) intraoperative radiation, nearly 7mm incision, 3-4d(3.2±0.2d) hospitalization time, and an average follow-up of 26.5±2.1 months(range, 24-30 months). No complication, such as dural laceration or nerve injury, occurred in operations. Intermittent claudication, lumbocrural pain, decreased sensation, and muscle strength had been improved in different degrees after surgery. All the patients were followed up for 24-30 months(26.5±2.1 months). Before surgery, 1 day, 1 month, 3 months, 6 months, 12 months, and 24 months after surgery, the waist pain VAS score was 4.80±1.46, 3.21±0.75, 1.88±1.15, 1.81±1.05, 0.63±0.62, 0.25±015, 0.28±0.12 respectively, and leg pain VAS score was 7.88±0.81, 2.88±1.45, 2.13±1.02, 1.38±0.62, 0.88±0.62, 0.81±0.54, 0.82±0.23 respectively. ODI score before surgery, 1 month, 3 months, 6 months, 12 months, and 24 months after surgery was 67.63±9.91, 38.4±10.46, 26.75±6.88, 13.81±5.95, 9.19±6.04, 9.22±4.56 respectively. Differences in lumbocrural pain scores and ODI scores between pre-operation and post-operation in multi-period were statistically significant(P<0.05). In the modified MacNab 24 months after surgery, the fineness rate was 90.5%, including 89 cases of excellence, 25 cases of good, and 12 cases of fair. Conclusions: Percutaneus endoscopic interlaminar decompression in DLSS has advantages in limited trauma, short intraoperative radiation exposure time, precise and thorough decompression, and fast recovery after surgery. The short-term outcomes are satisfactory.