Clinical effect evaluation and correlation between preoperative imaging parameters and clinical effect of endoscopic Transforaminal decompression for lumbar spinal stenosis.

BACKGROUND: The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis. METHODS: In this prospective study, 87 patients from Shanxi Province People's Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6 months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined. RESULTS: The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P < 0.01). A significant difference was observed between the 71-81 year age group and the other age groups (P < 0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal. CONCLUSION: Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71 years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.

[Clinical effects of percutaneous endoscopic transforaminal decompression for the treatment of lumbar spinal stenosis].

OBJECTIVE: To evaluate clinical effects of lumbar spinal stenosis by endoscopic transforaminal decompression, and to provide a theory basis for selection of surgical candidates. METHODS: From June 2014 to January 2016, clinical data of 87 patients with lumbar spinal stenosis were retrospectively analyzed, including 45 males and 42 females, aged from 25 to 81 years old with an average of 55.14 years old; 8 cases on L3,4, 61 cases on L4,5, 18 cases on L5S1. All patients underwent percutaneous edoscopic transforaminal decompression. Clinical symptoms and nerve functions were evaluated by VAS, ODI before operation, 3 and 6 months after operation, MacNab scoring was used to evaluate clinical effects. RESULTS: Postoperative incision of 87 patients healed well without complications, and obtained more than 6 months follow-up. VAS score before operation, 3 and 6 months after operation respectively were 63.88±8.56, 13.22±8.24, 6.83±9.43 respectively;ODI score before operation, 3 and 6 months after operation were 59.96±12.60, 9.08±10.55, 5.64±6.84 respectively. There was statistical significance in VAS and ODI score compared before operation and 3 and 6 months after operation. According to MacNab scoring, 41 cases obtained excellent results, 30 good, 7 moderate and 9 poor. CONCLUSIONS: Percutenous endoscopic transforaminal decompression for lumbar spinal stenosis could reach good clinical effects if choosing appropriate indications. For patients with yellow ligament hypertrophy or combined with some ossified stenosis, insufficient decompression may result in poor therapeutic effects.