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Title: [Early-effectiveness of unilateral biportal endoscopic laminectomy in treatment of two-level lumbar spinal stenosis].
Author: Zhang Y, Feng B, Su W, Liu D, Hu P, Lu H, Geng X.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Jun 15; 37(6):706-712. PubMed ID: 37331947.
Abstract:
OBJECTIVE: To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS). METHODS: The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L _{2, 3} and L _{3, 4} in 2 cases, L _{3, 4} and L _{4, 5} in 29 cases, L _{4, 5} and L _5, S ₁ in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated. RESULTS: All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%. CONCLUSION: UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory. 目的: 分析单侧双通道脊柱内镜技术（unilateral biportal endoscopy，UBE）椎管减压术治疗双节段腰椎管狭窄症（lumbar spinal stenosis，LSS）的早期临床疗效。. 方法: 回顾性分析2020年9月—2021年12月采用UBE椎管减压术治疗的98例双节段LSS患者临床资料。男53例，女45例；年龄32～79岁，平均59.9岁。其中混合型椎管狭窄56例，中央椎管型23例，神经根管型19例。病程1.5～10年，平均5.4年。手术节段：L _2、3、L _3、4 2例，L _3、4、L _4、5 29例，L _4、5和L ₅、S ₁ 67例。患者均有不同程度腰痛，单侧下肢症状76例、双侧下肢症状22例。双节段均行双侧减压者29例，均行单侧减压者63例，分别行单、双侧减压者6例。记录患者手术时间、术中出血量、切口总长度、住院时间、术后下地时间及相关并发症。采用疼痛视觉模拟评分（VAS）评估术前、术后3 d、术后3个月及末次随访时的腰痛和腿痛程度，采用Oswestry功能障碍指数（ODI）评估术前、术后3个月及末次随访时的功能改善情况，末次随访时采用改良MacNab标准评价疗效。手术前后行影像学检查，测量入路侧关节突保留率、改良Pfirrmann等级、椎间隙高度（disc height，DH）、腰椎前凸角（lumbar lordosis angle，LLA）和椎管横截面积（cross-sectional area of the canal，CAC）并计算CAC改善率。. 结果: 98例患者均顺利完成手术，手术时间（106.7±25.1）min，术中出血量（67.7±14.2）mL，切口总长度（3.2±0.4）cm，住院时间8（7，9）d，术后下地时间3（3，4）d。所有切口均Ⅰ期愈合。1例术中发生硬脊膜撕裂，1例术后轻度头痛。所有患者均获随访，随访时间13～28个月，平均19.3个月；随访期间无复发或再手术者。末次随访时，入路侧关节突保留率为84.7%±7.3%。改良Pfirrmann等级及DH与术前比较差异均有统计学意义（ P<0.05），LLA与术前比较差异无统计学意义（ P=0.050）；CAC较术前显著改善（ P<0.05），CAC改善率为108.1%±17.8%。术后各时间点腰痛和腿痛VAS评分及ODI均较术前明显改善，各时间点间两两比较差异均有统计学意义（ P<0.05）。末次随访时采用改良MacNab标准评价疗效，获优63例、良25例、中10例，优良率89.8%。. 结论: UBE椎管减压术治疗双节段LSS创伤小，恢复快，手术安全有效，早期临床疗效满意。.

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