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  • Title: [Effectiveness of unilateral biportal endoscopy combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures with neurological symptoms].
    Author: Yan T, Zeng J, Lin X, Hu H, Wu C.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Mar 15; 38(3):331-336. PubMed ID: 38500427.
    Abstract:
    OBJECTIVE: To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. METHODS: Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L 1 in 2 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture. RESULTS: All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation ( P<0.05), and further improved at last follow-up ( P<0.05). The ASIA scale after operation significantly improved when compared with that before operation ( P<0.05), and there was no significant difference ( P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation ( P<0.05), and without significant loss of correction during the follow-up ( P>0.05). CONCLUSION: Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function. 目的: 探讨单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）技术辅助椎管减压结合经皮单平面椎弓根螺钉内固定治疗合并神经损伤的腰椎爆裂骨折疗效。. 方法: 2021年6月—2022年12月收治10例合并神经损伤的单节段腰椎爆裂骨折患者，均接受UBE技术辅助下椎管减压结合经皮单平面椎弓根螺钉内固定治疗。其中男7例，女3例；年龄21～57岁，平均43.1岁。骨折节段：L 1 2例，L 2 4例，L 3 3例，L 4 1例。AO分型：A3型7例，A4型3例。骨折至手术时间2～5 d，平均3.3 d。记录总手术时间、镜下手术时间以及手术相关并发症发生情况。手术前后采用疼痛视觉模拟评分（VAS）、美国脊髓损伤学会（ASIA）分级（A～E级对应赋值1～5分进行统计分析），评估患者腰痛程度及神经功能；X线片、CT检查骨折愈合情况，测量伤椎前缘高度比、Cobb角及椎管侵占率。. 结果: 10例患者均顺利完成手术，在镜下完成减压及椎管内骨块复位。总手术时间90～150 min，平均119 min；镜下手术时间35～55 min，平均46 min。术中无硬膜囊、神经根及血管损伤等并发症发生。术后切口均Ⅰ期愈合。患者均获随访，随访时间10～28个月，平均18.7个月。术后 VAS评分较术前降低，末次随访时较术后1周进一步改善，各时间点间差异均有统计学意义（ P<0.05）。术后ASIA评分较术前改善（ P<0.05），术后1周及末次随访时差异无统计学意义（ P>0.05）。影像学复查示螺钉位置良好、关节突关节保留，随访期间均未发生内固定物松动、断裂及内固定失效等情况；伤椎前缘高度比、椎管侵占率、矢状面Cobb角均较术前改善（ P<0.05），末次随访与术后1周差异无统计学意义（ P>0.05）。. 结论: UBE技术辅助椎管减压结合经皮单平面椎弓根螺钉内固定是一种治疗合并神经损伤的腰椎爆裂骨折微创术式，在恢复椎体序列同时能有效解除椎管压迫，改善受损神经功能。.
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