Hu Yutong, Fu Hao, Yang Dongfang, Xu Weibing
Graduate School, Dalian Medical University, Dalian, China.
Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China.
Front Surg. 2023 Jan 6;9:1061566. doi: 10.3389/fsurg.2022.1061566. eCollection 2022.
To investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS).
We retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined.
The mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68 , contralateral was 65.07 ± 4.98 . The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral).
UBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.
探讨单侧双通道内镜（UBE）联合单侧椎板切开双侧减压（ULBD）治疗重度腰椎管狭窄症（SLSS）的临床疗效及影像学结果。
回顾性分析2018年10月至2021年3月采用UBE-ULBD治疗的50例SLSS患者。检测腰腿痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、改良Macnab标准、并发症、住院时间、术前和术后硬脊膜囊横截面积（DSCA）及Schizas分级、平均关节突切除角度和骨性侧隐窝减压率。
平均随访时间为10.7个月。平均住院时间为2.76±1.02天。末次随访时，腰背痛VAS评分从7.22±0.95降至1.26±0.44，腿痛VAS评分从7.88±0.69降至1.18±0.39；ODI从69.88±6.32%降至14.96±2.75%。根据改良Macnab标准，结果为优24例（48%），良22例（44%），可4例（8%）。92%的患者获得了优或良的结果（满意结果）。有2例硬脊膜囊撕裂并发症。术后DSCA较术前显著增大，从44.74±9.85增至126.86±14.81 mm。根据Schizas分级，狭窄程度从术前16例C级、34例D级，变为术后40例A级、10例B级。同侧关节突关节平均关节突切除角度为70.87±5.68°，对侧为65.07±4.98°。减压率同侧为70.81±4.43%，对侧为71.22±3.68%。
UBE-ULBD治疗SLSS临床效果良好，在椎管扩大、关节突关节咬除及减压效果方面均取得满意结果。它是一种治疗SLSS安全有效的手术方法。
