Merter Abdullah, Özyıldıran Mustafa, Shibayama Motohide, Ito Zenya, Nakamura Shu, Ito Fujio
Department of Orthopedics and Traumatology, Spine Surgery Section, Ankara University, Ankara, Turkey.
Department of Orthopedics and Traumatology, Sandıklı State Hospital, Afyonkarahisar, Turkey.
Neurospine. 2025 Mar;22(1):276-285. doi: 10.14245/ns.2448864.432. Epub 2025 Mar 31.
This study aimed to compare the clinical and comprehensive radiological outcomes of 3 types of endoscopic decompression surgery: unilateral biportal endoscopic lumbar decompression (UBELD), microendoscopic laminotomy (MEL), and percutaneous endoscopic lumbar decompression (PELD).
Patients with single-level lumbar spinal stenosis without instability were included in this multicenter retrospective study. Visual analogue scale (VAS) scores for each extremity, VAS back pain, and Japanese Orthopaedic Association (JOA) scores at preoperative and postoperative 1st, 6th, and 12th months were used as clinical outcome measures. In order to compare the radiological results of the patients, bilateral superior articular distance (SAD), bilateral lateral recess height (LR height), bilateral lateral recess angle (LR angle), and cross-sectional spinal canal area values were measured.
Eighty patients in the UBELD group, 73 patients in the MEL group, and 62 patients in the PELD group were included in the study. There was a statistically significant improvement in VAS scores and JOA scores in all groups compared to the preoperative period. At the 12th month postoperatively, the highest lateral decompression values on the approach side were determined as MEL (SAD: 4.1 mm, LR angle: 38.8°, LR height: 4.0 mm), followed by UBELD (SAD: 3.6 mm, LR angle: 36.2°, LR height: 3.3 mm) and PELD (SAD: 3.0 mm, LR angle: 21.7°, LR height: 2.3 mm), respectively. For the contralateral side, the highest lateral recess decompression values were listed as UBELD > MEL > PELD.
Effective decompression can be performed using all endoscopic techniques in lumbar spinal stenosis. However lateral recess decompression values were found to be better in UBELD and MEL techniques, compared to PELD.
本研究旨在比较三种类型的内镜减压手术的临床和综合影像学结果：单侧双孔道内镜下腰椎减压术（UBELD）、显微内镜下椎板切除术（MEL）和经皮内镜下腰椎减压术（PELD）。
本多中心回顾性研究纳入了无腰椎不稳的单节段腰椎管狭窄患者。采用术前及术后第1、6和12个月时各下肢的视觉模拟评分（VAS）、背痛VAS以及日本骨科协会（JOA）评分作为临床结局指标。为比较患者的影像学结果，测量了双侧上关节突间距（SAD）、双侧侧隐窝高度（LR高度）、双侧侧隐窝角度（LR角度）和椎管横截面积值。
本研究纳入了UBELD组80例患者、MEL组73例患者和PELD组62例患者。与术前相比，所有组的VAS评分和JOA评分均有统计学意义的改善。术后第12个月，手术侧最大侧隐窝减压值依次为MEL（SAD：4.1mm，LR角度：38.8°，LR高度：4.0mm）、UBELD（SAD：3.6mm，LR角度：36.2°，LR高度：3.3mm）和PELD（SAD：3.0mm，LR角度：21.7°，LR高度：2.3mm）。对侧的最大侧隐窝减压值依次为UBELD>MEL>PELD。
所有内镜技术均可有效治疗腰椎管狭窄。然而，与PELD相比，UBELD和MEL技术的侧隐窝减压效果更好。
