RESUMEN
BACKGROUD: Biportal endoscopic unilateral laminectomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for spinal stenosis. However, reports of the results associated with this surgical method are still lacking. METHODS: We conducted a retrospective study of 60 patients who underwent bilateral decompression for lumbar central canal stenosis. The patients were divided into 2 groups according to the surgical method (endoscopic ULBD vs. microscopic ULBD). We compared the outcomes between the 2 groups in terms of postoperative segmental spinal instability, dura expansion, operation time, estimated blood loss, serum creatine kinase (CK), serum C-reactive protein (CRP), visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab score, and the incidence of complications. RESULTS: The mean VAS, ODI, and modified MacNab score improved significantly from the preoperative period to the last follow-up in both groups and were better in the endoscopic ULBD group until the first day after treatment. The degree of horizontal displacement was lower in the endoscopic ULBD group than in the microscopic ULBD group at postoperative 12 months. Dura expansion, operation time, and estimated blood loss did not differ significantly between the 2 groups. Serum CK and CRP on the first day after treatment were lower in the endoscopic ULBD group than in the microscopic ULBD group. CONCLUSIONS: This study shows that both endoscopic ULBD and microscopic ULBD can provide favorable outcomes for lumbar central canal stenosis. However, compared to microscopic ULBD, endoscopic ULBD has advantages in terms of postoperative segmental spinal instability, pain control, and serum CK and CRP.
Asunto(s)
Descompresión Quirúrgica/métodos , Endoscopía/métodos , Laminectomía/métodos , Vértebras Lumbares/cirugía , Estenosis Espinal/cirugía , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Dimensión del Dolor , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the correlation between C2 incidence (C2I) and cervical and thoracolumbar sagittal parameters and determine the effectiveness of C2I for evaluating global spinopelvic sagittal alignment. METHODS: Whole spine standing lateral radiographs of 226 patients (mean age, 47.8 ± 11.3 years; 63% women) were analyzed. Spinopelvic parameters and incidence angles of inflection point were evaluated. The correlation between each parameter was analyzed using Pearson correlation coefficient and linear regression. Using C2I quartiles, 3 groups were compared to distinguish different alignment patterns by analysis of variance. RESULTS: C2I correlated significantly with C0-2 lordosis (C02L), C2-7 lordosis (C27L), C0-7 lordosis , C2 slope (C2S), T1 slope-C27L, C2-7 sagittal vertical axis, and chin brow vertical angle (CBVA) in cervical parameters (r = -0.378, r = 0.533, r = 0.251, r = 0.688, r = 0.681, r = 0.278, and r = 0.351, respectively; P < 0.01) and with T1 incidence (T1I), pelvic incidence-lumbar lordosis mismatch, L1 incidence (L1I), pelvic tilt (PT), and pelvic incidence (PI) (r = 0.480, r = 0.516, r = 0.518, r = 0.635, and r = 0.392, respectively; P < 0.01) in thoracolumbar alignment parameters. C2I was estimated by the 2 following equations: C2I = 1.0C2S + 1.0PT and C2I = 0.98PI - 0.99LL + 0.98 thoracic kyphosis - 1.0C27L (R2 = 0.97, P < 0.001, respectively), with an excellent coefficient of determination. PI, PT, L1I, T1I, and C2S were increased significantly between groups using C2I quartiles. In the high C2I group, C27L and C0-7 lordosis had less lordosis; however, C02L had more lordosis and C2-7 sagittal vertical axis and CBVA showed higher than low C2I group. CONCLUSIONS: C2I was significantly correlated with both cervical and thoracolumbar sagittal parameters, and different sagittal alignment patterns were presented regarding the amount of C2I. As the geometric summation from the pelvis to C2 vertebra, C2I would be a beneficial clue to connect correlation chains of spinal sagittal alignment.