Kim Ju Eun, Park Eugene J, Park Daniel K
From Baroseomyeon Hospital, Busan, Korea (Dr. Kim); Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine (Dr. E. J. Park); and Midwest Orthopedics at RUSH Chicago, IL (Dr. D. K. Park).
J Am Acad Orthop Surg Glob Res Rev. 2025 Sep 12;9(9). doi: 10.5435/JAAOSGlobal-D-24-00371. eCollection 2025 Sep 1.
Retrospective.
To compare long term clinical outcomes of single-level versus multilevel decompression using unilateral biportal endoscopic (UBE) decompression for degenerative lumbar spinal stenosis without instability.
Unilateral biportal endoscopic decompression has been shown to be effective in alleviating spinal stenosis without instability. Long-term data are lacking, and, in particular, a comparison between single-level and multilevel surgery using this minimally invasive technique has not been presented.
Ninety-eight patients in each group were propensity matched based on demographics. All patients had at least 5-year follow-up. Clinical outcomes, including Oswestry Disability Index, visual analog system (VAS), time to ambulation, surgical time, and length of hospital stay, were investigated.
Oswestry Disability Index improved from 62.98 ± 11.53 before surgery to 18.51 ± 8.63 at the final follow-up in single-level decompression (P < 0.001). Multilevel decompression demonstrated improvement from 64.66 ± 13.71 to 19.31 ± 9.42 (P < 0.001). Similarly, leg and back VAS decreased from 7.39 ± 0.91 and 6.11 ± 1.21 before surgery to 1.72 ± 0.548 and 1.82 ± 0.67 at the last follow-up (P < 0.001) for single-level decompression. In comparison, for the multilevel, leg and back VAS improved from 7.47 ± 1.09 and 6.29 ± 1.28 to 1.86 ± 0.58 and 1.91 ± 0.75 (P < 0.001). No difference was observed between the groups at any time point. Complications and revision rates did not differ. Time to ambulation and length stay was markedly longer in multilevel.
Outcomes, complication, and revision rates do not differ between single level and multilevel. UBE decompression can be applied to multiple levels without compromising outcomes if multiple-level decompression is deemed necessary.
回顾性研究。
比较采用单侧双通道内镜（UBE）减压术治疗无失稳的退变性腰椎管狭窄症时，单节段减压与多节段减压的长期临床疗效。
单侧双通道内镜减压术已被证明可有效缓解无失稳的椎管狭窄。目前缺乏长期数据，尤其是尚未有关于使用这种微创技术进行单节段与多节段手术比较的报道。
根据人口统计学特征对每组98例患者进行倾向匹配。所有患者均进行了至少5年的随访。调查临床疗效，包括奥斯威斯功能障碍指数、视觉模拟评分（VAS）、行走时间、手术时间和住院时间。
单节段减压组的奥斯威斯功能障碍指数从术前的62.98±11.53改善至末次随访时的18.51±8.63（P<0.001）。多节段减压组从64.66±13.71改善至19.31±9.42（P<0.001）。同样，单节段减压组术前腿部和背部的VAS分别为7.39±0.91和6.11±1.21，末次随访时降至1.72±0.548和1.82±0.67（P<0.001）。相比之下，多节段减压组术前腿部和背部的VAS分别为7.47±1.09和6.29±1.28，末次随访时改善至1.86±0.58和1.91±0.75（P<0.001）。两组在任何时间点均未观察到差异。并发症和翻修率无差异。多节段减压组的行走时间和住院时间明显更长。
单节段和多节段减压在疗效、并发症和翻修率方面无差异。如果认为有必要进行多节段减压，UBE减压术可应用于多个节段而不影响疗效。
