Clinical outcomes of foraminoplasty under endoscopy in the treatment of elderly lumbar lateral recess stenosis

English Keywords:Foraminoplasty  Lateral recess stenosis  Percutaneous endoscopy  Elderly

English Abstract:

  【Abstract】 Objectives: To analyze the clinical effect of endoscopic foraminoplasty in the treatment of lumbar lateral recess stenosis in elderly patients. Methods: The medical records of 150 patients who underwent surgery for lumbar lateral recess stenosis in our hospital from January 2018 to January 2019 were retrospectively analyzed, including 87 males and 63 females, aged 68.6±10.7 years(63-79 years) and were follwed up for 33.7±9.3(29-41) months. The patients were were divided into endoscopy group(n=92) treated with foraminoplasty under endoscopy and open group(n=58) treated with traditional lamine-fenestration spinal decompression surgery. The incision length, operation time, intraoperative blood loss, postoperative hospital stay, and complications between the two groups were compared, and the degree of decompression was evaluated by comparing the preoperative and postoperative 1 month bone lateral recess angle and soft lateral recess angle. The surgical effect was evaluated by visual anlog scale(VAS), Oswestry disability index(ODI) and MOS 36-item short-form health survey(SF-36) at preoperation and postoperative 1, 3, 6, and 12 months, and final follow-up, and the MacNab criteria were used to evaluate the clinical effect at the last follow-up. Subgroup analyses were performed according to different surgical segments to compare differences in efficacy. Results: The incision length of endoscopy group(9.36±1.40mm) was shorter than that of open group(30.90±7.95mm), and the difference was statistically significant(t=32.632, P=0.000). The intraoperative blood loss of the endoscopy group(27.17±5.12ml) was less than that of the open group(77.03±12.37ml) with significant difference(t=27.825, P=0.000). The postoperative hospital stay of the endoscopy group(3.34±0.91d) was shorter than that of the open group(5.00±1.16d) with significant difference(t=8.344, P=0.000). There was no significant difference in operation time between the two groups(P>0.05). CT and MRI at 1 month after surgery showed that there was no significant difference in bone and soft recess angles between the two groups(P>0.05). ODI of endoscopy group was lower than that of open group at 1 and 3 months after operation, and the differences were statistically significant(P<0.001). At final follow-up, the SF-36 score of endoscopy group(69.47±10.58) was higher than that of open group(61.36±10.26), and the difference was statistically significant(t=2.694, P=0.009). The VAS score, ODI and SF-36 score of the same group at each follow-up time after operation were significantly different from those before operation(P<0.05). 2 cases in the endoscopy group suffered nerve root injury, 2 cases in the endoscopy group and 4 cases in the open group suffered dural injury, and the condition changes of the patients were closely observed after surgery. The patients in the open group were successfully extubated, and 1 patient occurred fat liquefaction of the incision, and the healing of the incision was delayed after operation. The results of subgroup analyses were approximately the same as the overall results. Conclusions: Endoscopic foraminoplasty is superior in early postoperative recovery of lumbar function and improvement of quality of life in the long-term than traditional laminae-fenestration spinal decompression surgery in the treatment of elderly lumbar lateral recess stenosis.