Lee Dong Hyun, Lee Dong-Geun, Park Choon Keun, Jang Jae-Won, Hwang Jin Sub, Kim Jun Yong, Cho Yong-Eun, Lee Sang Won, Lee Dong Chan, Han Bang Sang, Han Sang Yeop
Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea.
Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Anyang, Korea.
Neurospine. 2023 Sep;20(3):931-939. doi: 10.14245/ns.2346504.252. Epub 2023 Sep 30.
This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage.
We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria.
The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures.
Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.
本研究旨在评估使用双侧-对侧单侧双通道内镜（UBE）减压治疗腰椎管狭窄症伴椎体滑脱，以尽量减少小关节损伤。
我们回顾性评估了2018年7月至2019年9月期间接受双侧-对侧UBE减压的42例1级椎体滑脱患者。为了确定节段性不稳定，回顾了术前和术后程序以及最终随访X线片的静态和动态图像。评估侧位X线片滑移率、矢状面活动度和小关节保留情况。使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和改良MacNab标准进行临床评估。
平均最终随访期为26.5±1.3个月。术前平均滑移百分比为15.70%±5.25%，在最终随访时恶化至18.80%±5.41%（p<0.005）。对侧小关节保留率为95.6%±4.1%。在最终随访时观察到VAS评分有所改善（腿痛：从7.9±2.2降至3.1±0.7；p<0.005；背痛：从7.2±3.0降至2.8±1.0；p<0.005）。术前平均ODI为26.19±3.42，改善至9.6±1.0（p<0.005）。13例患者在减压后出现延迟性节段性不稳定。尽管大多数延迟性不稳定患者无症状或经保守治疗后有所改善，但有2例患者需要进行融合手术以解决不稳定问题。此外，2例患者出现小关节滑膜囊肿，2例发生棘突骨折。
对侧UBE入路双侧减压可能是一种有效且可替代的治疗方法，可减少1级椎体滑脱所致腰椎管狭窄症的不稳定。
