Evaluation of Hidden Blood Loss and Clinical Outcomes of Arthroscopy-Assisted Uni-Portal Spinal Surgery for Lumbar Disc Herniation with Lateral Recess Stenosis.

OBJECTIVE

This study aims to evaluate hidden blood loss (HBL) and its influencing factors in patients with lumbar disc herniation-related lateral recess stenosis who underwent arthroscopy-assisted uni-portal spinal surgery (AUSS). Additionally, the study assesses clinical outcomes at the 6-month postoperative follow-up.

METHODS

This study included 129 patients with lumbar disc herniation-associated lateral recess stenosis who underwent AUSS during the year 2024. Demographic data and parameters related to blood loss were recorded. HBL was calculated using the Nadler and Gross formulas. Pearson or Spearman correlation analyses were performed to explore the relationships between patient characteristics and HBL. Multiple linear regression analysis was used to identify independent risk factors for HBL. Primary clinical outcomes (visual analog scale scores) and secondary outcomes (Oswestry Disability Index scores and the modified Macnab criteria) were assessed preoperatively and at 3 days, 3 months, and 6 months postoperatively. Longitudinal data were analyzed using generalized mixed linear models.

RESULTS

A total of 129 consecutive patients (66 females and 63 males) were enrolled. The average HBL was 414.34 ± 179.15 ml. Correlation analyses (Pearson and Spearman) revealed significant associations between surgical duration, American Society of Anesthesiologists (ASA) score, muscle thickness, preoperative activated partial thromboplastin time, and preoperative D-dimer with HBL (P < 0.05). Multiple linear regression analysis identified surgical duration and ASA score as independent risk factors for HBL. Postoperative visual analog scale and Oswestry Disability Index scores showed significant improvement compared to preoperative values.

CONCLUSIONS

The amount of HBL in patients undergoing AUSS should not be underestimated. ASA score and surgical duration are independent risk factors for HBL. AUSS, as an improved technique, significantly alleviates postoperative pain and enhances quality of life, demonstrating good short-term clinical efficacy. It is an effective treatment option for lateral recess stenosis caused by lumbar disc herniation.