Tsai Sung Huang Laurent, Chang Chia-Wei, Lin Tung-Yi, Wang Ying-Chih, Wong Chak-Bor, Ghaith Abdul Karim, Alvi Mohammed Ali, Fu Tsai-Sheng, Bydon Mohamad
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, Chang Gung University, F7, No 222 Mai-King Road, Keelung 20401, Taiwan.
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN 55902, USA.
J Clin Med. 2023 Feb 2;12(3):1180. doi: 10.3390/jcm12031180.
Case Series and Technical Note, Objective: UBS has been extensively used in open surgery. However, the use of UBS during UBESS has not been reported in the literature. The aim of this study was to describe a new spinal surgical technique using an ultrasonic bone scalpel (UBS) during unilateral biportal endoscopic spine surgery (UBESS) and to report the preliminary results of this technique.
We enrolled patients diagnosed with lumbar spinal stenosis who underwent single-level UBESS. All patients were followed up for more than 12 months. A unilateral laminotomy was performed after bilateral decompression under endoscopy. We used the UBS system after direct visualization of the target for a bone cut. We evaluated the demographic characteristics, diagnosis, operative time, and estimated blood loss of the patients. Clinical outcomes included the visual analog scale (VAS), the Oswestry Disability Index (ODI), the modified MacNab criteria, and postoperative complications.
A total of twenty patients (five males and fifteen females) were enrolled in this study. The mean follow-up period was 13.2 months (range 12-17 months). The VAS score, ODI, and modified MacNab criteria classification improved after the surgery. A minimal mean blood loss of 22.1 mL was noted during the operation. Only one patient experienced neuropraxia, which resolved within 2 weeks. There was no durotomy, iatrogenic pars fracture, or infection.
In conclusion, our study represents the first report of the use of UBS during UBESS. Our findings demonstrate that this technique is safe and efficient, with improved clinical outcomes and minimal complications. These preliminary results warrant further investigation through larger clinical studies with longer follow-up periods to confirm the effectiveness of this technique in the treatment of lumbar spinal stenosis.
病例系列与技术说明。目的：超声骨刀（UBS）已在开放手术中广泛应用。然而，文献中尚未报道在单侧双通道内镜脊柱手术（UBESS）中使用UBS的情况。本研究的目的是描述一种在单侧双通道内镜脊柱手术（UBESS）中使用超声骨刀（UBS）的新脊柱手术技术，并报告该技术的初步结果。
我们纳入了诊断为腰椎管狭窄症并接受单节段UBESS的患者。所有患者均随访超过12个月。在内镜下双侧减压后进行单侧椎板切开术。在直接可视化目标后使用UBS系统进行骨切割。我们评估了患者的人口统计学特征、诊断、手术时间和估计失血量。临床结果包括视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、改良MacNab标准和术后并发症。
本研究共纳入20例患者（5例男性和15例女性）。平均随访期为13.2个月（范围12 - 17个月）。术后VAS评分、ODI和改良MacNab标准分类均有所改善。手术期间平均失血量极少，为22.1 mL。仅1例患者出现神经失用，在2周内恢复。无硬脊膜切开、医源性椎弓根骨折或感染。
总之，我们的研究是关于在UBESS中使用UBS的首次报告。我们的研究结果表明，该技术安全有效，临床结果改善且并发症极少。这些初步结果需要通过更大规模、更长随访期的临床研究进一步调查，以证实该技术在治疗腰椎管狭窄症中的有效性。
