Clinical study of minimally invasive decompression in the treatment of degenerative lumbar spinal stenosis

doi:10.3877/cma.j.issn.2096-0263.2021.02.004

Abstract

Abstract:

Objective

To analyze and compare the clinical effects of two endoscopic surgical methods (PELD and MED) in the treatment of degenerative lumbar spinal stenosis (LSS), and to study the therapeutic advantages of the two surgical methods.

Methods

The medical records of LSS patients receiving PELD (36 cases) and MED (36 cases) in the spinal surgery department of Yichang Central People's Hospital, Hubei Province from January 2018 to December 2019 were retrospectively analyzed. In the PELD group, there were 18 male and 18 female patients, aged (61.56±9.87) years. There were 20 males and 16 females (62.61±9.19 years old) in the MED group. Relevant clinical indicators, VAS score of leg pain, ODI score, improved MacNab standard and complications in the third month after surgery were calculated.

Results

All patients were followed up with a follow-up rate of 100%. The follow-up time of the PELD group was 3-7 months, with an average of (3.98±2.43) months. The follow-up time of the MED group was 4-9 months, with an average of (4.52±2.92) months. The length of incision, intraoperative blood loss, postoperative incision exudation time, postoperative bed rest and hospitalization time in the PAD group [(0.81±0.16) cm, (13.75±5.52) ml, (2.12±1.35) d, (15.29±4.64) h, (5.25±1.72) d] were all lower than those in the Med group [(1.89±0.25) cm, (32.05±8.34) ml, (4.37±2.56) h, (59.35±11.32) h, (6.47±2.03) d]. The differences were statistically significant (all P<0.05). However, the operative time [(83.65±17.69) min] and the number of intraoperative fluoroscopy [(3.72±1.45) times] in the MED group were less than those in the PELD group [(95.14±23.21) min and (13.25±4.32) times], and the difference was statistically significant (P<0.05). There was no significant difference in hospitalization expenses between the two groups [PELD group: (2.54±0.29) ten thousand; MED group: (2.51±0.42) ten thousand. Between the two group patients on the first day after operation, postoperative 1 month, 3 months after operation VAS comparison between groups (F=6.466, 5.261, 4.326, P=0.013, 0.025, 0.041) and postoperative 1 month, 3 months after operation of ODI (%) score (F=6.073, 5.071, P=0.016, 0.027), the difference had statistical significance (P<0.05), two groups of patients with leg pain VAS and ODI at each time point in the group (%) score difference had statistical significance (P<0.001), with the extension of time, The VAS and ODI (%) scores of leg pain decreased gradually. MacNab standard evaluation of surgical efficacy showed that the two surgical methods had high effective rate (>90%) and excellent and good rate (>85%), there was no significant difference between groups, there was no statistical significance (P>0.05).

Conclusions

PELD and MED have their own advantages, and both of them are effective methods to treat LSS under the premise of grasping its applicable scope.

Key words: Minimally invasive, Endoscopic, Spinal, lumbar vertebra, Stenosis

peng Zhang, Fengping Liu, Yang Liu, Hongwei Zhao. Clinical study of minimally invasive decompression in the treatment of degenerative lumbar spinal stenosis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(02): 85-92.

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Figures/Tables 6

References 28

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组别	例数	性别（例，男/女）	年龄（岁，±s）	体重（kg，±s）	病程（年，±s）	腰椎管狭窄节段（例，L_3～4/L_4～5/L₅～S₁）
PELD组	36	18/18	61.56±9.87	57.63±10.32	1.25±0.36	5/16/15
MED组	36	20/16	62.61±9.19	60.59±10.12	1.33±0.43	3/18/15
统计值		χ²=0.223	t=0.467	t=1.229	t=0.856	χ²=0.623
P值		0.637	0.641	0.223	0.395	0.732

组别	例数	性别（例，男/女）	年龄（岁，±s）	体重（kg，±s）	病程（年，±s）	腰椎管狭窄节段（例，L_3～4/L_4～5/L₅～S₁）
PELD组	36	18/18	61.56±9.87	57.63±10.32	1.25±0.36	5/16/15
MED组	36	20/16	62.61±9.19	60.59±10.12	1.33±0.43	3/18/15
统计值		χ²=0.223	t=0.467	t=1.229	t=0.856	χ²=0.623
P值		0.637	0.641	0.223	0.395	0.732

组别	例数	手术切口长度（cm）	手术时间（min）	术中透视次数（次）	术中出血量（ml）	术后切口渗出时间（d）	术后卧床时间（h）	住院时间（d）	住院费用（万）
PELD组	36	0.81±0.16	95.14±23.21	13.25±4.32	13.75±5.22	2.12±1.35	15.29±4.64	5.25±1.72	2.54±0.29
MED组	36	1.89±0.25	83.65±17.69	3.72±1.45	32.05±8.34	4.37±2.56	59.35±11.32	6.47±2.03	2.51±0.42
t值		21.832	2.362	12.548	11.160	4.665	21.728	2.751	0.353
P值		<0.001	0.021	<0.001	<0.01	<0.001	<0.001	0.008	0.725

组别	例数	手术切口长度（cm）	手术时间（min）	术中透视次数（次）	术中出血量（ml）	术后切口渗出时间（d）	术后卧床时间（h）	住院时间（d）	住院费用（万）
PELD组	36	0.81±0.16	95.14±23.21	13.25±4.32	13.75±5.22	2.12±1.35	15.29±4.64	5.25±1.72	2.54±0.29
MED组	36	1.89±0.25	83.65±17.69	3.72±1.45	32.05±8.34	4.37±2.56	59.35±11.32	6.47±2.03	2.51±0.42
t值		21.832	2.362	12.548	11.160	4.665	21.728	2.751	0.353
P值		<0.001	0.021	<0.001	<0.01	<0.001	<0.001	0.008	0.725

组别	例数	术前一天	术后第一天	术后1个月	术后3个月	F值	P值
PELD组	36	7.09±1.05	5.47±0.81^*	1.81±0.77^*#	1.05±0.62^*#&	440.779	<0.001
MED组	36	6.98±0.94	5.98±0.89^*	2.24±0.82^*#	1.39±0.76^*#&	317.168	<0.001
F值		0.219	6.466	5.261	4.326
P值		0.641	0.013	0.025	0.041

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