Tian Dasheng, Zhu Bin, Liu Jianjun, Chen Lei, Sun Yisong, Zhong Huazhang, Jing Juehua
Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Surg. 2022 Oct 31;9:959390. doi: 10.3389/fsurg.2022.959390. eCollection 2022.
Unilateral biportal endoscopic (UBE)surgery is being increasingly adopted as a minimally invasive technique. The purpose of the current study was to introduce a novel surgical technique for lateral recess and same-level foraminal decompression by the contralateral inclinatory approach with unilateral biportal endoscopy(CIA-UBE) at the lumbar level.
Between January 2020 and February 2022, 10 patients suffering from lateral recess and same-level foraminal stenosis at the lumbar level underwent UBE surgery by contralateral inclinatory approach (CIA-UBE). Magnetic resonance imaging (MRI) scans were examined after surgery to measure the cross-sectional area (CSA) of the spinal canal (CSA-SC), the CSA of the intervertebral foramen (CSA-IVF), and the CSA of the facet joint (CSA-FJ). Postoperative radiologic images using computed tomography (CT) were obtained to investigate the existence of facet joint violation. Clinical outcomes were assessed using Oswestry Disability Index (ODI) scores and visual analogue scale (VAS) scores for buttock and radicular pain.
Ten levels were decompressed, and the mean age of the patients was 56.92 ± 13.26 years. The mean follow-up period was 7.60 ± 4.47 months. The average operative time was 85.14 ± 25.65 min. Postoperative CT and MRI revealed ideal neural decompression of the treated segments in all patients. CSA-IVF and CSA-FJ improved significantly, indicating good foraminal and lateral recess decompression with less damage to facet joints. Preoperative VAS and ODI scores improved significantly after surgery.
CIA-UBE may be an effective surgical treatment of the lateral recess and same-level foraminal stenosis at the lumbar level, which provides successful surgical decompression for traversing and exiting nerve roots with a better operative view and easier surgical manipulation. This approach may also help to maximize the preservation of the facet joint.
单侧双通道内镜（UBE）手术作为一种微创技术正被越来越多地采用。本研究的目的是介绍一种通过腰椎水平对侧倾斜入路联合单侧双通道内镜（CIA-UBE）进行侧隐窝和同节段椎间孔减压的新型手术技术。
2020年1月至2022年2月，10例患有腰椎水平侧隐窝和同节段椎间孔狭窄的患者接受了对侧倾斜入路（CIA-UBE）的UBE手术。术后进行磁共振成像（MRI）扫描，以测量椎管横截面积（CSA-SC）、椎间孔横截面积（CSA-IVF）和小关节横截面积（CSA-FJ）。使用计算机断层扫描（CT）获得术后影像学图像，以研究小关节损伤情况。使用Oswestry功能障碍指数（ODI）评分以及臀部和神经根性疼痛的视觉模拟量表（VAS）评分评估临床结果。
对10个节段进行了减压，患者的平均年龄为56.92±13.26岁。平均随访期为7.60±4.47个月。平均手术时间为85.14±25.65分钟。术后CT和MRI显示所有患者治疗节段均实现了理想的神经减压。CSA-IVF和CSA-FJ显著改善，表明椎间孔和侧隐窝减压良好，对小关节的损伤较小。术后术前VAS和ODI评分显著改善。
CIA-UBE可能是治疗腰椎水平侧隐窝和同节段椎间孔狭窄的有效手术方法，它为横过和穿出神经根提供了成功的手术减压，具有更好的手术视野和更简便的手术操作。这种方法也可能有助于最大限度地保留小关节。
