Xu Xuyang, Zhang Zhiqiang, Wang Zijie, Zhang Liang, Cai Jun, Feng Xinmin, Ding Yu, Zhang Yi
Medical College, Yangzhou University, Yangzhou Jiangsu, 225001, P. R. China.
Department of Orthopedics, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou Jiangsu, 225001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 May 15;39(5):612-619. doi: 10.7507/1002-1892.202502068.
To explore decompression strategies for lateral lumbar spinal stenosis under unilateral biportal endoscopy (UBE) assistance.
A clinical data of 86 patients with lateral lumbar stenosis treated with UBE-assisted intervertebral decompression between September 2022 and December 2023 was retrospectively analyzed. There were 42 males and 44 females with an average age of 63.6 years (range, 45-79 years). The disease duration ranged from 6 to 14 months (mean, 8.5 months). Surgical levels included L in 3 cases, L in 26 cases, L in 42 cases, and L , S in 15 cases. According to Lee's grading system, there were 21 cases of grade 1, 37 cases of grade 2, and 28 cases of grade 3 for lumbar spinal stenosis. Based on the location of stenosis and clinical symptoms, the 33 cases underwent interlaminar approach, 7 cases underwent interlaminar approach with auxiliary third incision, 26 cases underwent contralateral inclinatory approach, and 20 cases underwent paraspinal approach; then, the corresponding decompression procedures were performed. Visual analogue scale (VAS) score was used to evaluate lower back/leg pain before operation and at 1 and 3 months after operation, while Oswestry disability index (ODI) was used to evaluate spinal function. At 3 months after operation, the effectiveness was evaluated using the modified MacNab evaluation criteria. The spinal stenosis and decompression were evaluated based on Lee's grading system using lumbar MRI before operation and at 3 months after operation.
All procedures were successfully completed with mean operation time of 95.1 minutes (range, 57-166 minutes). Dural tears occurred in 2 cases treated with interlaminar approach with auxiliary third incision. All incisions healed by first intention. All patients were followed up 3-10 months (mean, 5.9 months). The clinical symptoms of the patients relieved to varying degrees. The VAS scores and ODI of lower back and leg pain at 1 and 3 months after operation significantly improved compared to preoperative levels ( <0.05), and the indicators at 3 months significantly improved than that at 1 month ( <0.05). According to the modified MacNab evaluation criteria, the effectiveness at 3 months after operation was rated as excellent in 52 cases, good in 21 cases, and poor in 13 cases, with an excellent and good rate of 84.9%. No lumbar instability was detected on flexion-extension X-ray films during follow-up. The Lee's grading of lateral lumbar stenosis at 2 days after operation showed significant improvement compared to preoperative grading ( <0.05).
For lateral lumbar spinal stenosis, UBE-assisted decompression of the spinal canal requires the selection of interlaminar approach, interlaminar approach with auxiliary third incision, contralateral inclinatory approach, and paraspinal approach based on preoperative imaging findings and clinical symptoms to achieve better effectiveness.
探讨单侧双通道内镜（UBE）辅助下腰椎侧隐窝狭窄的减压策略。
回顾性分析2022年9月至2023年12月期间接受UBE辅助椎间减压治疗的86例腰椎侧隐窝狭窄患者的临床资料。其中男性42例，女性44例，平均年龄63.6岁（范围45 - 79岁）。病程6至14个月（平均8.5个月）。手术节段包括L₃ 3例，L₄ 26例，L₅ 42例，L₅、S₁ 15例。根据Lee分级系统，腰椎管狭窄症1级21例，2级37例，3级28例。根据狭窄部位及临床症状，33例行椎板间入路，7例行椎板间入路辅助第三切口，26例行对侧倾斜入路，20例行椎旁入路；然后进行相应的减压手术。采用视觉模拟评分（VAS）评估术前及术后1个月和3个月的腰/腿痛情况，采用Oswestry功能障碍指数（ODI）评估脊柱功能。术后3个月，采用改良MacNab评估标准评估疗效。术前及术后3个月采用腰椎MRI基于Lee分级系统评估腰椎管狭窄及减压情况。
所有手术均顺利完成，平均手术时间95.1分钟（范围57 - 166分钟）。椎板间入路辅助第三切口治疗的2例患者发生硬膜撕裂。所有切口均一期愈合。所有患者随访3 - 10个月（平均5.9个月）。患者临床症状均有不同程度缓解。术后1个月和3个月腰腿痛的VAS评分及ODI较术前显著改善（P < 0.05），且3个月时指标较1个月时显著改善（P < 0.05）。根据改良MacNab评估标准，术后3个月疗效评定为优52例，良21例，差13例，优良率为84.9%。随访期间屈伸位X线片未发现腰椎不稳。术后2天腰椎侧隐窝狭窄的Lee分级较术前分级有显著改善（P < 0.05）。
对于腰椎侧隐窝狭窄，UBE辅助椎管减压需根据术前影像学表现及临床症状选择椎板间入路、椎板间入路辅助第三切口、对侧倾斜入路及椎旁入路，以取得更好疗效。
