Hospital Privado de Rosario, Universidad de Rosario, Rosario City, Santa Fe, Argentina.
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
World Neurosurg. 2024 Aug;188:e93-e107. doi: 10.1016/j.wneu.2024.05.047. Epub 2024 May 15.
BACKGROUND: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS: We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS: The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS: FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.
背景:退行性腰椎疾病是全球导致残疾和旷工的主要原因。腰椎微切除术已成为治疗椎间盘突出症和狭窄性疾病的标准治疗方法。随着不同技术的发展,内窥镜脊柱手术应运而生,在尽量减少手术创伤的同时,提供至少不劣于开放手术的效果。目前,有两种不同类型的内窥镜脊柱手术主导着手术领域:“全内窥镜”(FE)和单侧双通道内窥镜(UBE)脊柱手术。本研究旨在描述和分析它们的适应证,以及它们的技术特点及其优缺点,预测未来的发展趋势。
方法:我们通过 Pub Med 搜索,对截至 2023 年 8 月发表的最相关文章进行了叙述性综述。使用的搜索词是“FE 脊柱手术”和“UBE 脊柱手术”。选择的文章由 3 名作者独立审查,共审查了 55 篇全文文章。
结果:描述了 FE 和 UBE 脊柱手术技术。FE 技术采用单通道在持续盐水灌洗下进行。FE 包括经椎间孔和经椎板入路,适应证取决于要治疗的病变,仍存在争议。UBE 还可以从后路、后外侧和脊柱旁入路对脊柱进行治疗。它使用两个不同的端口针对一个目标进行连续灌洗。建立这两个端口的过程称为三角化。
结论:FE 和 UBE 脊柱手术已经证明了与开放手术相当的结果,同时最小化了并发症和手术创伤。
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