Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Orthop Surg. 2023 Dec;15(12):3153-3161. doi: 10.1111/os.13928. Epub 2023 Oct 19.
Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes.
Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used.
Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria.
UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.
经皮单通道全内镜单侧椎板切开双侧减压术（UFE-ULBD）已被用于治疗腰椎管狭窄症（LSS），并取得了满意的效果。然而，目前仅有少数研究探讨了减压范围与临床结果之间的关系。本研究旨在探讨 UFE-ULBD 治疗单节段 LSS 的疗效，并探讨减压范围与功能结果之间的关系。
回顾性分析了 2021 年 11 月至 2023 年 2 月间采用经皮单通道全内镜单侧椎板切开双侧减压术（UFE-ULBD）治疗的单节段 LSS 患者。收集患者的人口统计学资料、腿痛和腰痛的视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）评分、改良 MacNab 分级、影像学结果，包括椎间盘-黄韧带间隙的减压比、骨性侧隐窝的扩大比、上关节突间隔的扩大比、椎管横截面积（DSCA）。采用独立样本 t 检验、配对样本 t 检验、卡方检验、Fisher 确切检验以及 Pearson 和 Spearman 相关性分析。
本研究共纳入 40 例患者（男 23 例，女 17 例），平均随访时间为 12 个月。末次随访时，腿痛 VAS 评分从 6.0±0.8 降至 1.0±1.9（p<0.001），腰痛 VAS 评分从 6.0±0.8 降至 1.2±1.8（p<0.001）；ODI 评分从 71.7±6.2 降至 24.3±21.3（p<0.001）。根据改良 MacNab 标准，结果为优 28 例（70%）、良 5 例（12.5%）、可 6 例（15%）、差 1 例（2.5%），优良率为 82.5%。术后 DSCA 从 57.69±21.86 扩大至 150.75±39.33mm（p<0.001），扩大率为 189.43±107.83%。根据改良 MacNab 标准，在临床和影像学参数方面，优、良、可、差组之间无差异。
UFE-ULBD 可在单节段 LSS 患者中提供满意的临床和影像学结果。在充分暴露硬膜囊边界的情况下，UFE-ULBD 治疗 LSS 患者的功能结果与影像学减压范围无关。
