Clinical Efficacy Assessment of Single-Hole Split Endoscopy Integrated with Percutaneous Pedicle Screw Fixation for Multi-Segmental Lumbar Spinal Stenosis Treatment
Objective To retrospectively analyzed the clinical efficacy of one-hole split endoscope(OSE)combined with percutaneous pedicle screw fixation(PPSF)in the treatment of multi-segments lumbar spinal stenosis(MLSS).Methods A retrospective cohort study was designed to evaluate the clinical outcomes of 52 patients undergoing surgical interventions for multi-segmental lumbar spinal stenosis(MLSS)at Beijing Civil Aviation General Hospital from January 2021 to March 2023.The OSE fusion Group(n=30),comprising patients with preoperative lumbar instability who underwent a combined one-hole split endoscopy(OSE)decompression and percutaneous pedicle screw fixation(PPSF)for fusion;and the OSE decompression Group(n=22),consisting of patients without preoperative lumbar instability who underwent OSE decompression alone.Demographic characteristics,including age and gender,were recorded.Comparative analyses were conducted for surgical parameters such as surgical duration,intraoperative blood loss,postoperative hospital stay,wound drainage volume.intraoperative fluoroscopy frequency,and surgical complications.Additionally,preoperative,1-week postoperative,and final follow-up assessments were made using the visual analogue scale(VAS)for lower back and leg pain,and the Oswestry Disability Index(ODI).Imaging parameters,namely lumbar lordosis angle(LLA)and mean disc height(MDH)of the affected segment,were also evaluated.Results All patients completed the follow-up period,with the OSE fusion group having a follow-up duration ranging from 12 to 32 months,averaging at(18.36±9.45)months,and the OSE decompression group being followed up for 12 to 30 months,averaging(17.94±10.23)months.Statistically significant differences(P＜0.05)were observed between the two groups regarding surgical time,intraoperative blood loss,postoperative wound drainage volume,postoperative hospital stay,and intraoperative fluoroscopy frequency.One week postoperatively and at the final follow-up,both groups demonstrated significantly reduced VAS scores and ODI for back and lower limb pain compared to preoperative levels,with these differences being statistically significant(P＜0.05).In the OSE fusion group,the MDH and LLA were significantly higher at 1 week and the last follow-up compared to preoperative values,displaying statistically significant differences(P＜0.05).A total of 3 surgical complications occurred,all within the OSE fusion group.Two patients experienced transient exacerbation of nerve damage symptoms,attributed to intraoperative nerve root involvement.These patients underwent postoperative low-dose hormone therapy,dehydration treatment,nerve nutrition,and intensified rehabilitation exercises,resulting in gradual symptom improvement.Additionally,one patient experienced an intraoperative dural tear,which was immediately repaired during surgery.Postoperatively,the patient was instructed to remain bedridden with the head lower than the feet and a wound drainage tube was placed,leading to subsequent improvement.Conclusion The preliminary findings of this study suggest that both OSE decompression alone and the combined approach of OSE fusion with PPSF demonstrate promising clinical outcomes.Notably,the integration of OSE with PPSF effectively mitigates the clinical symptoms in patients with MLSS,showcasing advantages such as minimized intraoperative trauma,reduced blood loss,clear surgical visualization,procedural flexibility,and accelerated postoperative recovery.Hence,it is imperative to meticulously assess the indications and select the appropriate surgical approach tailored to the individual patient's clinical presentation,signs,and imaging findings,thereby achieving personalized and precise minimally invasive treatment for MLSS.
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