Wang Wen-Long, Liu Zheng, Wu Si-Jun
Department of Orthopedics, Shougang Hospital, Health Science Centre, Peking University, Beijing, China.
Front Surg. 2022 Jul 5;9:944509. doi: 10.3389/fsurg.2022.944509. eCollection 2022.
Unilateral biportal endoscopy (UBE) is a relatively new yet common minimally invasive procedure in spine surgery, capable of achieving adequate decompression for lumbar spinal stenosis through unilateral laminectomy bilateral decompression (ULBD). Neither additional fusion nor rigid fixation is required, as UBE-ULBD rarely causes iatrogenic lumbar instability. However, to our knowledge, five-level ULBD two-stage UBE without lumbar fusion has been yet to be reported in the treatment of multilevel lumbar spinal stenosis.
We present a case of an 80-year-old female patient who developed progressive paralysis of the lower extremities. Radiographic examinations showed multilevel degenerative lumbar spinal stenosis and extensive compression of the dural sac and nerve roots from L1-2 to L5-S1. The patient underwent five-level ULBD through two-stage UBE without lumbar fusion or fixation. One week after the final procedure, the patient could ambulate with walking aids and braces. Moreover, no back pain or limited lumbar motion was observed at the 6-month follow-up.
Multilevel ULBD through UBE may provide elderly patients with an alternative, minimally invasive procedure for treating spinal stenosis. This procedure could be achieved by staging surgeries. In this case, we reported complaints of little back pain, despite not needing to perform lumbar fusion or fixation.
单侧双通道内镜技术（UBE）是脊柱外科中一种相对较新但常见的微创手术，能够通过单侧椎板切除双侧减压（ULBD）实现对腰椎管狭窄的充分减压。由于UBE-ULBD很少导致医源性腰椎不稳，因此无需额外的融合或坚强内固定。然而，据我们所知，五级ULBD两阶段UBE且不进行腰椎融合治疗多节段腰椎管狭窄的情况尚未见报道。
我们报告一例80岁女性患者，出现进行性下肢瘫痪。影像学检查显示多节段退变性腰椎管狭窄，硬脊膜囊和神经根从L1-2至L5-S1受到广泛压迫。该患者通过两阶段UBE接受了五级ULBD，未进行腰椎融合或固定。最后一次手术后一周，患者可借助助行器和支具行走。此外，在6个月的随访中未观察到背痛或腰椎活动受限。
通过UBE进行多节段ULBD可为老年患者提供一种治疗椎管狭窄的替代微创方法。该手术可通过分期手术完成。在本病例中，我们报告患者尽管未进行腰椎融合或固定，但背痛较轻。
