Feng Xinwen, Wang Bin, Ding Jiangping, Niu Ben, Muhetaer Wumaier, Yang Hongtao, Chen Rong, Ma Chao
Department of Spinal Surgery, Xinjiang Bazhou People's Hospital, Korla, Xinjiang Uygur Autonomous Region, China.
Medicine (Baltimore). 2025 May 23;104(21):e42594. doi: 10.1097/MD.0000000000042594.
Unilateral biportal endoscopic discectomy (UBE) and microendoscopic discectomy (MED) are well-established minimally invasive techniques for managing single-segment degenerative lumbar spinal stenosis (DLSS). However, current evidence from evidence-based medicine remains insufficient to conclusively demonstrate the comparative advantages of these methods.
A total of 145 patients diagnosed with single-segment DLSS were enrolled from the spinal surgery department of Xinjiang Bazhou People's Hospital between January 2022 and August 2024. Fourteen patients were lost to follow-up, leaving 131 valid cases. Participants were divided into 2 groups: UBE (n = 70) and MED (n = 61), based on the surgical approach. The study compared the demographic and clinical characteristics of both groups (gender, age, disease duration, height, weight, BMI, and affected segment), perioperative metrics (operation time, blood loss, and hospital stay), and clinical outcomes at various time points (preoperatively, 3 days postoperatively, 1-month postoperatively, 3 months postoperatively, 1-year postoperatively, and 2 years postoperatively), including visual analogue scale (VAS) scores for back and leg pain, Oswestry disability index (ODI) scores, and imaging parameters (preoperative and postoperative disc height and dural sac expansion area).
All patients completed follow-up for over 2 years. The UBE group demonstrated significantly shorter operation times, reduced blood loss, and shorter hospital stays compared to the MED group (P < .05). No significant differences in VAS scores for back and leg pain or ODI scores were found between the groups at preoperative and postoperative time points (P > .05). Both groups showed significant improvements in VAS scores for back and leg pain and ODI scores at all postoperative time points relative to preoperative levels (P < .05). No significant differences in dural sac expansion area or disc height (preoperative and postoperative) were noted between the groups (P > .05).
Both UBE and MED are effective treatments for single-segment DLSS, achieving substantial spinal canal decompression and improvement in clinical symptoms. UBE, however, offers advantages over MED in terms of shorter surgical time, reduced blood loss, and shorter hospital stays.
单侧双通道内镜下椎间盘切除术（UBE）和显微内镜下椎间盘切除术（MED）是治疗单节段退变性腰椎管狭窄症（DLSS）成熟的微创手术技术。然而，目前循证医学的证据仍不足以确凿证明这些方法的比较优势。
2022年1月至2024年8月期间，从新疆巴音郭楞蒙古自治州人民医院脊柱外科招募了145例诊断为单节段DLSS的患者。14例患者失访，最终纳入有效病例131例。根据手术方式将参与者分为两组：UBE组（n = 70）和MED组（n = 61）。本研究比较了两组的人口统计学和临床特征（性别、年龄、病程、身高、体重、BMI和受累节段）、围手术期指标（手术时间、失血量和住院时间）以及不同时间点（术前、术后3天、术后1个月、术后3个月、术后1年和术后2年）的临床结局，包括腰腿痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分和影像学参数（术前和术后椎间盘高度及硬脊膜囊扩张面积）。
所有患者均完成了超过2年的随访。与MED组相比，UBE组的手术时间明显更短，失血量更少，住院时间更短（P < 0.05）。术前和术后各时间点，两组之间的腰腿痛VAS评分或ODI评分均无显著差异（P > 0.05）。与术前水平相比，两组在所有术后时间点的腰腿痛VAS评分和ODI评分均有显著改善（P < 0.05）。两组之间在硬脊膜囊扩张面积或椎间盘高度（术前和术后）方面无显著差异（P > 0.05）。
UBE和MED都是治疗单节段DLSS的有效方法，均可实现充分的椎管减压并改善临床症状。然而，UBE在手术时间更短、失血量更少和住院时间更短方面优于MED。
