Ke Tianyao, He Qiulin, Wang Qiying, Li Long, Shi Changgui, Zeng Jiaxue, Li Qing
Department of Orthopaedics, Liupanshui Hospital, The Affiliated Hospital of Guizhou Medical University, Liupanshui, China.
Spinal Minimally Invasive Center of the Second Affiliated Hospital of the Naval Medical University of the People's Liberation Army of China (Shanghai Long March Hospital), Shanghai, China.
Asian Spine J. 2025 Aug;19(4):600-608. doi: 10.31616/asj.2024.0002. Epub 2025 Apr 11.
STUDY DESIGN: Single-center retrospective cohort analysis. PURPOSE: To compare surgical outcomes between the unilateral biportal endoscopic (UBE) and open microdiscectomy for the treatment of single-level lumbar disc herniation (LDH). OVERVIEW OF LITERATURE: Open microdiscectomy remains the gold standard for LDH, while UBE has emerged as a minimally invasive alternative. However, comparative evidence on efficacy, safety, and recovery profiles remains limited. METHODS: This was a single-center retrospective analysis of 46 patients with single-level LDH who underwent either the UBE surgery (n=22) or open microdiscectomy (n=24) between January 2020 and December 2022. Demographic information, perioperative data, and radiographic measurements were reviewed. Pain intensity, patient satisfaction, and quality of life were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) at 1-week, 3-month, and 12-month follow-ups. RESULTS: The mean operative time in the UBE group (86.1±11.4 minutes) was significantly longer than in the open microdiscectomy group (72.3±8.0 minutes, p=0.032). UBE was associated with significantly lower estimated blood loss (54.1±13.7 mL vs. 92.5±11.6 mL, p=0.001) and shorter hospital stay (3.7±1.2 days vs. 6.6±1.4 days, p=0.001). The mean VAS score for back pain at 1 week was significantly better in the UBE group (1.88±0.60 vs. 3.59±0.72, p=0.004). However, both surgical techniques showed similar long-term results regarding disc height, disc angle changes, and patient-reported outcomes. CONCLUSIONS: Despite the longer operative time, UBE is associated with reduced estimated blood loss and shorter hospital stays, offering a minimally invasive alternative with early postoperative pain relief. Conversely, open microdiscectomy, the conventional treatment approach, demonstrates comparable efficacy in long-term clinical outcomes despite its more invasive nature. Both methods show similar rates of complications and recurrent disc herniation. UBE is a viable alternative to open microdiscectomy, depending on individual patient considerations and surgical preferences.
研究设计：单中心回顾性队列分析。 目的：比较单侧双孔道内镜（UBE）手术与开放显微椎间盘切除术治疗单节段腰椎间盘突出症（LDH）的手术效果。 文献综述：开放显微椎间盘切除术仍是LDH的金标准，而UBE已成为一种微创替代方法。然而，关于疗效、安全性和恢复情况的比较证据仍然有限。 方法：这是一项单中心回顾性分析，纳入了2020年1月至2022年12月期间接受UBE手术（n = 22）或开放显微椎间盘切除术（n = 24）的46例单节段LDH患者。回顾了人口统计学信息、围手术期数据和影像学测量结果。在术后1周、3个月和12个月的随访中，使用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估疼痛强度、患者满意度和生活质量。 结果：UBE组的平均手术时间（86.1±11.4分钟）显著长于开放显微椎间盘切除术组（72.3±8.0分钟，p = 0.032）。UBE的估计失血量显著更低（54.1±13.7 mL对92.5±11.6 mL，p = 0.001），住院时间更短（3.7±1.2天对6.6±1.4天）p = 0.001）。UBE组术后1周背痛的平均VAS评分显著更好（1.88±0.60对3.59±0.72，p = 0.004）。然而，两种手术技术在椎间盘高度、椎间盘角度变化和患者报告的结果方面显示出相似的长期结果。 结论：尽管手术时间较长，但UBE与估计失血量减少和住院时间缩短相关，提供了一种具有早期术后疼痛缓解的微创替代方法。相反，开放显微椎间盘切除术作为传统的治疗方法，尽管其侵入性更强，但在长期临床结果中显示出相当的疗效。两种方法显示出相似的并发症和复发性椎间盘突出率。根据个体患者的考虑因素和手术偏好来看，UBE是开放显微椎间盘切除术的可行替代方法。
Cochrane Database Syst Rev. 2014-9-4
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