双ortal 内窥镜脊柱手术与传统显微手术术后硬膜外血肿形成的比较:随机对照试验

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-11-08 DOI:10.14444/8578
Dae-Woong Ham, Jeuk Lee, Byung-Taek Kwon, Yisack Yoo, Sang-Min Park, Kwang-Sup Song
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引用次数: 0

摘要

背景:双入口内窥镜脊柱手术(BESS)已被广泛认为是脊柱减压和椎间盘切除术的微创方法。然而,由于术后硬膜外血肿(POEH)可能压迫神经元并导致神经功能缺损,因此在脊柱手术中存在很大风险。本研究比较了 BESS 与传统显微手术的临床和放射学结果:在这项单中心、单盲、主动控制的随机临床试验中,共招募了46名因椎管狭窄或椎间盘突出而接受单水平后路减压或椎间盘切除术的患者。参与者被随机分配到传统显微手术组或 BESS 组。所有手术均由经验丰富的脊柱外科医生实施。术后在移除引流系统后进行磁共振成像评估。结果测量包括硬膜囊横截面积(CSA)、POEH以及神经功能缺损的发生率:两组患者的人口统计学特征和基线特征相似,传统组 24 人,BESS 组 22 人。两组患者术前和术后硬膜囊 CSA 无明显差异。不过,BESS 组 POEH 的 CSA(0.36 ± 0.34 平方厘米)明显大于传统组(0.17 ± 0.15 平方厘米,P = 0.033)。尽管POEH发生率较高,但神经功能缺损或翻修手术并未相应增加:研究结果表明,虽然 BESS 的减压效果与传统显微手术相当,但硬膜外血肿的发生率较高。重要的是,这些血肿并没有导致神经功能恶化或手术干预需求的增加。要证实这些结果并进一步完善 BESS 技术,还需要进行样本量更大、随访时间更长的进一步研究:尽管硬膜外血肿的发生率较高,但BESS的减压效果与显微手术相当,且不会增加神经系统风险,因此是一种可行的、创伤较小的患者护理选择:
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Comparison of Postoperative Epidural Hematoma Formation Between Biportal Endoscopic Spine Surgery and Conventional Microscopic Surgery: A Randomized Controlled Trial.

Background: Biportal endoscopic spine surgery (BESS) has become widely recognized as a minimally invasive method for spinal decompression and discectomy. However, postoperative epidural hematoma (POEH) presents a significant risk in spinal surgery due to its potential to compress neural elements and lead to neurological deficits. This study compares the clinical and radiological outcomes of BESS with those of conventional microscopic surgery.

Methods: In this single-center, single-blinded, actively controlled randomized clinical trial, 46 patients undergoing single-level posterior decompression or discectomy for spinal stenosis or herniated intervertebral discs were enrolled. Participants were randomly allocated to either the conventional microscopic surgery group or the BESS group. Experienced spine surgeons performed all procedures. Postoperative magnetic resonance imaging assessments were conducted following the removal of the drain system. Outcome measures included the cross-sectional area (CSA) of the dura sac and POEH, as well as the incidence of neurological deficits.

Results: The demographic and baseline characteristics of the patients were similar across the 2 groups, with 24 in the conventional group and 22 in the BESS group. There were no significant differences in the preoperative and postoperative CSA of the dura sac between the groups. However, the BESS group exhibited a significantly larger CSA of POEH (0.36 ± 0.34 cm²) compared with the conventional group (0.17 ± 0.15 cm², P = 0.033). Despite this higher incidence of POEH, there was no corresponding increase in neurological deficits or revision surgeries.

Conclusion: The findings indicate that while BESS achieves decompression comparable to that of conventional microscopic surgery, it is associated with a higher incidence of epidural hematomas. Importantly, these hematomas did not result in an increased rate of neurological deterioration or the need for surgical interventions. Further studies with larger sample sizes and extended follow-up are required to confirm these results and further refine the BESS technique.

Clinical relevance: Despite a higher incidence of epidural hematomas, BESS offers comparable decompression to microscopic surgery without increased neurological risks, making it a viable, less invasive option for patient care.

Level of evidence: 2:

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
期刊最新文献
Editorial: Embracing Rasch Analysis for Enhanced Spine Surgery Outcomes-The Outsider's Viewpoint. Editors' Introduction: High-Value Endoscopic Techniques: Integrating Surgeon Skill and Experience in Spine Surgery With Rasch Analysis. Invited Commentary: Rasch Analysis and High-Value Spinal Endoscopy. Letter to the Editor: Articles and Accompanying Editorials on Rasch Analysis of High-Value Endoscopic Surgeries-A Message From the ISASS Co-President. Letter to the Editor: Hierarchy of Evidence.
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