Analysis of the efficacy and prognosis of percutaneous spinal endoscopic surgery versus traditional posterior laminectomy for thoracic ossification of the ligamentum flavum

doi:10.11958/20253703

Abstract

Abstract:

Objective To compare the clinical efficacy of percutaneous spinal endoscopic surgery and traditional posterior laminectomy in the treatment of thoracic ossification of the ligamentum flavum (TOLF), and to analyze prognostic influencing factors. Methods A retrospective analysis was conducted on the clinical data of 167 patients with TOLF who were treated in the spinal orthopedics department of our hospital from January 2017 to December 2023. The patients were divided into the control group (n=54) and the observation group (n=113) based on their own condition and treatment willingness to undergo surgery. The control group received traditional posterior laminectomy surgery, while the observation group underwent percutaneous spinal endoscopic surgery. The surgical indicators, therapeutic effects and complication rates of the two groups were compared. The patients were followed up for 6 months, and the Japanese Orthopedic Association Assessment Scale (JOA) score improvement rate was used to classify them into the favorable prognosis group and the unfavorable prognosis group. Univariate analysis was conducted on the indicators between the two groups to identify the statistically significant ones, and then multiple-factor Logistic regression analysis was further conducted to screen influencing factors for unfavorable prognosis in TOLF patients. Results The bleeding volume was less in the observation group than that in the control group. The hospitalization time, operation time and time to start walking after surgery were all shorter in the observation group than those in the control group. The postoperative Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS) scores were lower in the observation group than those in the control group, while the JOA score was higher in the observation group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Based on the JOA score improvement rate at 6 months postoperatively, in 167 patients, 116 cases (69.5%) were in the favorable prognosis group and 51 cases (30.5%) were in the unfavorable prognosis group. The multivariate Logistic regression analysis revealed that the intramedullary high signal on the preoperative T2-weighted image (OR=4.667, 95%CI: 2.075-10.497, P<0.001) and postoperative cerebrospinal fluid leakage (OR=6.738, 95%CI: 2.625-17.295, P<0.001) were independent risk factors affecting the prognosis of TOLF patients, while the preoperative residual rate of thoracic spinal canal area>80% (OR=0.421, 95%CI: 0.189-0.936, P=0.034) was an independent protective factor for the prognosis of TOLF patients. Conclusion The therapeutic effect of percutaneous spinal endoscopic treatment for TOLF is superior to that of traditional posterior laminectomy. Preoperative intramedullary high signal on T2-weighted images, preoperative residual rate of the thoracic spinal canal area and cerebrospinal fluid leakage are prognostic factors for patients with TOLF.

Key words: endoscopy, prognosis, thoracic vertebrae, ossification of the ligamentum flavum, therapeutic effect, influencing factors

CLC Number:

R681.5

Figures/Tables 7

References 17

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组别		n	年龄/岁		性别
组别		n	年龄/岁		男		女
对照组		54	51.80±3.42		30（55.6）		24（44.4）
观察组		113	51.25±3.59		69（61.1）		44（38.9）
t或χ²			0.937		0.459
组别	病程/年			骨化分型
组别	病程/年			孤立型		连续型		跳跃型
对照组	4.29±1.08			15（27.8）		20（37.0）		19（35.2）
观察组	4.19±0.83			35（31.0）		43（38.1）		35（31.0）
t或χ²	0.639			0.335

组别		n	年龄/岁		性别
组别		n	年龄/岁		男		女
对照组		54	51.80±3.42		30（55.6）		24（44.4）
观察组		113	51.25±3.59		69（61.1）		44（38.9）
t或χ²			0.937		0.459
组别	病程/年			骨化分型
组别	病程/年			孤立型		连续型		跳跃型
对照组	4.29±1.08			15（27.8）		20（37.0）		19（35.2）
观察组	4.19±0.83			35（31.0）		43（38.1）		35（31.0）
t或χ²	0.639			0.335

组别	n	术中出血量/mL	住院时间/d	手术时间/min	下地行走时间/d
对照组	54	163.00±47.23	7.16±0.51	96.06±20.27	4.87±0.34
观察组	113	109.00±30.18	5.37±0.33	89.24±18.95	2.42±0.50
t		8.935^＊＊	27.166^＊＊	2.126^＊	32.709^＊＊

组别	n	术中出血量/mL	住院时间/d	手术时间/min	下地行走时间/d
对照组	54	163.00±47.23	7.16±0.51	96.06±20.27	4.87±0.34
观察组	113	109.00±30.18	5.37±0.33	89.24±18.95	2.42±0.50
t		8.935^＊＊	27.166^＊＊	2.126^＊	32.709^＊＊

组别	n			JOA评分
组别	n			术前			术后			t
对照组	54			5.17±0.58			7.52±0.50			22.551^＊＊
观察组	113			5.23±0.44			8.71±0.46			58.114^＊＊
t				0.783			15.215^＊＊
组别		ODI评分
组别		术前			术后				t
对照组		24.57±3.31			12.61±2.24				21.990^＊＊
观察组		24.70±4.06			10.39±2.06				33.412^＊＊
t		0.197			6.334^＊＊
组别			NRS评分
组别			术前			术后		t
对照组			6.52±0.50			2.89±0.42		40.850^＊＊
观察组			6.43±0.52			2.36±0.48		61.137^＊＊
t			1.002			6.860^＊＊