Minimally Invasive Lumbar Decompression Long-term Outcome, Morbidity, and the Learning Curve From the First 50 Cases

作者：Mannion Richard J^*; Guilfoyle Matthew R; Efendy Johnny; Nowitzke Adrian M; Laing Rodney J; Wood Martin J

来源：Journal of Spinal Disorders & Techniques, 2012, 25(1): 47-51.

DOI：10.1097/BSD.0b013e31820baa1e

• minimally invasive
• lumbar canal stenosis
• surgery
• outcome
• complications

Study Design: Prospective observational study.
Objective: To describe our experience with the first 50 cases of minimally invasive lumbar canal decompression in terms of patient outcome up to 2 years, the learning curve incurred, and complications when compared with our most recent 50 cases.
Summary of Background Data: Lumbar canal stenosis is a common condition in the elderly population, the symptoms of which respond well to surgical decompression. A minimally invasive approach offers potential short and long-term benefits to patients but the technique is associated with a learning curve and equivalence to open surgery regarding efficacy and complications needs to be demonstrated.
Methods: Fifty patients (mean age 70 y) who presented with clinical and radiological features of lumbar canal stenosis and who had failed a period of conservative management underwent lumbar canal decompression through a paramedian oblique, muscle splitting approach using a 16 to 18mm operating tube and microscope. Outcome was assessed using the Oswestry Disability Index and Short Form-36 at 3 months, 1 year, and 2 years.
Results: Significant clinical improvements were seen at 3 months that were sustained at 1 and 2 years. Clinical outcome improved whereas operative time and complications fell as experience increased, helping to define the learning curve with this technique.
Conclusions: Minimally invasive lumbar decompression seems to offer patients a clinical benefit comparable to that observed in published open series, with potential advantages in terms of postoperative pain and recovery. However, there is a learning curve and whether this technique offers long-term benefits with regard to a reduction in back pain or postoperative spondylolisthesis is not yet known.

• 出版日期2012-2