Percutaneous Endoscopic Foraminoplasty for Lumbar Spinal Lateral Stenosis

經皮內視鏡治療腰椎外側狹窄初期報告

徐少克(Shao-Keh Hsu) ； 郭家孝(Chia-Hsiao Keo) ； 陳聖祺(Sheng-Chi Chen)

《童綜合醫學雜誌》 10卷2期 (2016/12) Pp. 21-28

摘要

Background: This article reports the preliminary results from a study on the efficacy and feasibility of percutaneous endoscopic foraminoplasty (PEF) in the treatment of lumbar spinal lateral stenosis. Methods: This prospective study included 38 patients (mean age, 73 years; range, 62–88 years) fulfilling the following inclusion criteria: (1) degenerative lumbar foraminal stenosis with or without lateral recess stenosis; (2) neurological claudication with sciatica; (3) MR/CT confirmation of the pathology; or (4) failed conservative management of at least 3 months. These patients underwent PEF under local, aware-state anesthesia. Results: On evaluation with the MacNab scale, the results for patients in the foraminal and lateral recess stenosis sub-group were less satisfactory than those for patients in the foraminal stenosis sub-group (65% vs. 83%). The overall success rate was 76%. The VAS pain scale score showed an average improvement of 4.5 points. The Oswestry Disability Index score showed a ＞20% improvement in 30 patients (30/38: 79%) and a ＜20% improvement in eight patients (8/38: 21%) at the 2-year follow-up. No neurovascular injuries were reported. Two patients had transient postoperative dysesthesia. Conclusions: PEF is a safe and effective method for the treatment of lumbar spinal foraminal stenosis, particularly in elderly and medically-compromised patients in whom general anesthesia is not recommended. Careful preoperative evaluation and appropriate patient selection is crucial to obtaining satisfactory outcomes, following arthroscopic foraminal decompression. However, patients with severe degenerative spondylosis associated with advanced bony lateral recess stenosis would not benefit from this operative procedure.

關鍵字

Percutaneous ； endoscope ； foraminoplasty ； transforaminal ； lateral recess stenosis ； foraminal stenosis

並列摘要

本文報導了一個初步的結果，經皮內視鏡下椎孔成形術下治療腰椎管外側狹窄的可行性和療效。38例病患，平均年齡73歲（範圍62-88歲）被列入本前瞻性研究。入選標準1. 退行性腰椎間孔狹窄帶或不帶側隱窩狹窄。2. 神經性跛行與坐骨神經痛。3. 病理性的MR/ CT確認。4. 至少3個月的保守治療無效。所有病患皆在局部感知麻醉狀態下進行經皮內視鏡椎孔成形術。建立在MacNab疼痛評分基礎上，病患同時有椎間孔及側隱窩狹窄組比單純椎間孔狹窄者不滿意（65%比83%），總滿意率為76%。在VAS疼痛評分提高4.5點的平均值。在兩年隨訪： Oswestry功能障礙指數得分：30位患者改善超過20%（30/38 79%）和8位患者改善小於20%（21% 8/38）。無神經血管損傷併發症產生。只有兩個病人出現暫時性的術後神經性異常疼痛。經皮內視鏡下椎孔成形術是治療腰椎間孔狹窄的一種安全又有效的方法，特別是對於不適用於全身麻醉的老人和嚴重內科疾病的患者。仔細的術前評估和適當的患者選擇是達成手術滿意極為重要的項目。患者有較嚴重的骨性側隱窩狹窄及嚴重退行性病變不適用於這種手術方式。

並列關鍵字

經皮內視鏡 ； 椎孔成形術 ； 椎間孔間狹窄 ； 側隱窩狹窄