Early outcomes of unilateral laminectomy for bilateral decompression under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly

English Keywords:Lumbar spinal stenosis  Full endoscopic  Unilateral approach  Bilateral decompression  Elderly

English Abstract:

  【Abstract】 Objectives: To investigate the early outcomes of unilateral laminectomy for bilateral decompression(ULBD) under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly. Methods: 37 patients with single-segment lumbar spinal stenosis treated via ULBD under full endoscopic with large portal from July 2018 to July 2020 in our hospital were retrospectively analyzed. There were 17 males and 20 females, averaged 66.8±4.9(60-78) years. 7 cases were operated at L3-4, 20 cases at L4-5, and 10 cases at L5-S1. Data of patients and intraoperative complications were collected. The pain visual analog scale(VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index(ODI) was used to evaluate the lumbar function recorded before operation, at 1 week, 3 months, and 1 year after operation. One year after operation, the clinical curative effect was evaluated by MacNab standard. Results: Of all the patients, the average operative time was 113.7±19.4min(75-155min), intraoperative blood loss was 26.5±9.4ml(10-50ml), and the length of hospitalization was 5.5±0.7 days(5-7 days). 1 case of dural sac tear occurred during operation, and the patient was strictly bedridden for one week after collagen sponge closure. The patient did not show any obvious clinical symptoms, and the wound healed well. The preoperative, one week, three months and one year postoperative VAS scores for low back pain were 5.4±0.5, 2.4±0.6, 1.0±0.5 and 0.4±0.5, respectively, and the VAS scores for leg pain were 7.3±0.5, 2.7±0.5, 1.3±0.5 and 0.7±0.6, respectively, and the ODI were (78.6±2.3)%, (26.0±4.1)%, (17.4±2.2)%, and (10.7±2.0)%, respectively. The VAS score of low back pain and leg pain and ODI score at each time point after operation were significantly improved when compared with those before operation(P<0.001), and the values at each time point after operation were significantly different when compared pairwise(P<0.001). The clinical efficacy was evaluated 1 year after surgery using MacNab criteria, and 21 cases were classified as excellent, 13 cases as good, 3 cases as acceptable and 0 cases as poor, with an excellent rate of 91.89%. Conclusions: The early outcomes of ULBD under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly are good, but further follow-up is required for long-term outcomes.