Preliminary clinical outcomes of one-hole split endoscopy for treating moderate-severe lumbar spinal stenosis

English Keywords:One-hole split endoscope  Unilateral biportal endoscopy  Lumbar spinal stenosis  Decompression  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To compare the early clinical efficacy of one-hole split endoscopy(OSE) and unilateral biportal endoscopy(UBE) technique in the treatment of moderate-severe lumbar spinal stenosis. Methods: Patients with moderate-severe lumbar spinal stenosis treated via OSE and UBE techniques in our department from January 2021 till July 2021 were analyzed retrospectively. According to the inclusion criteria, 159 patients were included, which were divided into OSE group and UBE group. There were 80 cases in the UBE group(32 males and 48 females) averaged 59.63±7.97 years old, with a mean body mass index(BMI) of 23.27±1.73kg/m2; 10 cases were operated at L3/4, 45 cases at L4/5, and 25 cases at L5/S1; 47 cases were decompressed unilaterally and 33 cases bilaterally. OSE group consisted of 79 cases(37 males and 42 females) averaged 56.70±11.75 years old, with a BMI of 23.64±1.76kg/m2; 8 cases were operated at L3/4, 50 cases at L4/5, and 21 cases at L5/S1; 48 cases were decompressed unilaterally and 31 cases bilaterally. Data such as length of hospitalization, operation time, incision length, and intraoperative blood loss were counted and compared between groups. Moreover, range of motion(ROM) and sagittal translation(ST) on lumbar dynamic X-rays, axial articular surface length and angle of the cutting surface of the facet joint of 3D CT, and axial spinal canal cross-sectional area of T2-weighted MRI of the surgical segment before and after operation were recorded. The visual analogue scale(VAS) was employed to evaluate of low back and leg pain before operation and at different time points(the second day, 3 months, 1 year) after surgery, the Oswestry disability index(ODI) was used to evaluate functional improvement, and the clinical efficacy was evaluated by modified Macnab criteria at final follow-up. All the clinical scores before and after surgery were analyzed and compared between groups. Results: All the patients underwent surgical intervention successfully. There was no statistical significance in length of hospitalization, operation time or intraoperative blood loss between groups(P>0.05). Comparing with the UBE group, the OSE group had smaller incision length(2.12±0.22cm vs 2.70±0.40cm), and the difference was statistically significant(P<0.05). The VAS scores for low back and leg pain on the next day after operation, at three-month and one-year of both groups were significantly improved than those preoperatively(P<0.05). The ODI at postoperative three-month and one-year were significantly lower than those preoperatively(P<0.05). The values at each time point within groups were significantly different when compared pairwise(P<0.05), while no significant difference was found between the two groups(P>0.05). There was no statistical significance between preoperative and postoperative ST and ROM of surgical segment respectively of both groups, and there was no statistical significance between groups(P>0.05). There was no significant difference in angle of facetectomy and facet preservation rate between the two groups(P>0.05). The spinal canal cross-sectional area of the surgical segment postoperatively of both groups were significantly larger than those preoperatively with statistical difference(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in the excellent and good rate between the two groups 1 year after operation(P>0.05). Conclusions: OSE technique and UBE technique can achieve sufficient decompression for the treatment of moderate and severe lumbar spinal stenosis with certain early clinical efficacy, and the long-term efficacy requires further follow-up.