Kim Seung-Kook, Kang Sang-Soo, Hong Young-Ho, Park Seung-Woo, Lee Su-Chan
The Spine Center, Himchan Hospital, 118 Yongdam-ro, Yunsoo-gu, Incheon, 21927, South Korea.
Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, South Korea.
J Orthop Surg Res. 2018 Jan 31;13(1):22. doi: 10.1186/s13018-018-0725-1.
The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient's satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures.
This study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2-L3 to L5-S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications.
The study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups (p < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant.
The UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain.
Not applicable.
单侧双通道内镜（UBE）技术是一种用于脊柱手术的微创手术，而开放性显微椎间盘切除术是腰椎间盘破裂或突出最常见的手术治疗方法。一种采用UBE方法的新型内镜技术已应用于传统关节镜系统来治疗脊柱疾病。在本研究中，我们旨在比较和评估UBE与开放性腰椎显微椎间盘切除术（OLM）在单节段椎间盘切除术中的围手术期参数和临床结果，包括手术恢复情况、疼痛和生活质量改善、患者满意度以及并发症。
本研究纳入了141例患有退行性椎间盘疾病且需要在L2 - L3至L5 - S1单节段进行椎间盘切除术的患者。分别有60例和81例患者接受了UBE和OLM手术。分析基于围手术期指标的比较，包括手术时间（OT）；估计失血量（EBL）；住院时间（HS）；临床结果，包括使用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）进行评估；患者满意度（MacNab评分）；以及再次手术和并发症的发生率。
研究队列中女性占56.7%，患者平均年龄为50.98±18.23岁。两组患者从术前到最后一次随访时，平均VAS（背部和腿部）、MacNab评分和ODI均有显著改善（12.92±3.92）（p < 0.001）。术后1周，UBE组的背部VAS评分改善明显优于OLM组。然而，两组在术后1周、3个月和12个月时的VAS（背部和腿部）、ODI改善情况、改良MacNab评分和OT并无显著差异。在UBE组中，EBL（34.67±16.92）较OLM组（140.05±57.8）少，HS（2.77±1.2）较OLM组（6.37±1.39）短。然而，UBE组的OT（70.15±22.0）比OLM组（60.38±15.5）长，且差异具有统计学意义。同时，两组在手术转换率和并发症方面的差异无统计学意义。
单节段椎间盘切除术采用UBE与OLM的临床结果相似，包括疼痛控制、功能障碍和患者满意度，但术中EBL、HS及术后背痛最小。
不适用。
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