Clinical efficacy of percutaneous endoscopic decompression in treating lumbar spinal stenosis combined with degenerative scoliosis in geriatric patients

English Keywords:Percutaneous endoscopic decompression  Lumbar spinal stenosis  Degenerative scoliosis  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis(LSS) with degenerative scoliosis in geriatric patients. Methods: A retrospective analysis was conducted on the LSS patients combined with degenerative scoliosis underwent percutaneous endoscopic decompression between January 2020 and June 2021. 18 patients(11 males and 7 females) aged 65-90(78.9±7.1) years old were included in the study. Percutaneous endoscopic unilateral or bilateral decompression was performed according to the clinical symptoms, comorbidities and imaging characteristics of the patients. The operative time, intraoperative blood loss and fluoroscopy times were recorded. Visual analogue scale(VAS) was used to evaluate back and leg pain before and immediately after operation, and at 6 months after surgery and final follow-up. Oswestry disability index(ODI) and Japanese Orthopaedic Association(JOA) score were applied to evaluate lumbar function before and after operation, and the Macnab criteria were adopted to assess the efficacy at final follow-up. The sagittal vertical axis(SVA), C7-CSVL, Cobb angle, lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), PI-LL, and cross-sectional area of spinal canal before and after surgery were measured and analyzed. Results: All the patients underwent the surgery successfully, and 14 cases were treated with bilateral decompression and 4 cases with unilateral decompression. There were no serious complications during the perioperative period. The patients completed more than 12 months of follow-up. The operative time was 69.72±12.66min, intraoperative blood loss was 39.72±10.21mL, and the number of preoperative and intraoperative fluoroscopy was 5.11±1.49 times. The VAS scores of low back and leg pain immediately after operation, at 6 months after operation and final follow-up were significantly lower than those before operation(P<0.05). The ODI and JOA score at final follow-up were significantly improved compared with those before operation(P<0.05). The postoperative SVA, C7-CSVL, Cobb angle, PI-LL, and cross-sectional areas of spinal canal were improved compared with the preoperative values, respectively(P<0.05). There were 7 excellent cases(38.90%), 9 good cases(50.00%) and 2 acceptable cases(11.11%) at the final follow-up, and the total excellent and good rate was 88.89%. Conclusions: Percutaneous endoscopic decompression has the clinical efficacies of relieving back and leg pain, improving lumbar function and spino-pelvic alignment, and enlarging intraspinal cross-sectional area in treating old LSS patients with degenerative scoliosis, and it is small in wound, little in bleeding, and short in operative time.