A comparison of the clinical efficacies of unilateral decompression and bilateral decompression under one-hole split endoscope for lumbar spinal stenosis with unilateral symptom

English Keywords:One-hole split endoscope  Lumbar spinal stenosis  Unilateral decompression  Bilateral decompression  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To explore the early clinical efficacies of unilateral decompression and bilateral decompression by one-hole split endoscope(OSE) technique for moderate-severe lumbar spinal stenosis(LSS) with unilateral symptoms amongst middle aged and elderly people. Methods: A retrospective analysis was performed on the patients with moderate-severe LSS who underwent unilateral decompression and bilateral decompression using OSE technique between January 2021 and December 2021. According to the inclusion and exclusion criteria, a total of 120 patients were enrolled in this study, with 60 patients in the unilateral decompression group(group A) and 60 patients in the bilateral decompression group(group B). The length of hospitalization, operative time, incision length and intraoperative blood loss were counted and compared between group A and group B. Moreover, range of motion(ROM) and sagittal translation(ST) on lumbar dynamic X-ray, facet preservation rate on the approach side, and cross-sectional area of the canal(CAC) of the surgical segment before and after operation were recorded and compared. The visual analogue scale(VAS) of back and leg pain was used before surgery, and at 7 days, 3 months and 18 months after surgery, the Oswestry disability index(ODI) was used to evaluate the functional improvement, and the clinical efficacy was evaluated by modified Macnab criteria at the last follow-up. All the clinical scores of both groups were analyzed and compared between before and after surgery. Results: All the patients underwent surgical intervention successfully. There was no statistical significance in the length of hospitalization between groups A and B(P>0.05), but group B was longer in operative time, bigger in incision, and more in blood loss than group A, with statistical significance(P<0.05). The VAS for back and leg pain and the ODI after operation in both groups were all significantly lower than those before surgery, respectively (P<0.05), and the values at each postoperative time point within group were significantly different when compared pairwise(P<0.05); There was no significant difference between the two groups before surgery(P>0.05), but group B had more significant improvement than group A at 7 days, 3 months and 18 months after surgery(P<0.05). There was no statistical significance in ST and ROM of surgical segment before and after surgery between the two groups(P>0.05). The postoperative facet preservation rate was higher in group B than in group A(P＜0.05). There was no significant difference in the CAC of the surgery segment before operation between the two groups(P>0.05), however, the CAC of the surgical segment in group B was larger than that in group A(P<0.05). The rate of improvement in CAC was higher in group B than in group A(P<0.05). The CAC of the surgical segment postoperatively in both groups were significantly larger than before surgery, with statistical significance(P<0.05). Excellent-good rate at 18 months after surgery was 86.7% in group A and 91.7% in group B. There was no significant difference in the number of excellent and good cases between the two groups at 18 months after operation(P>0.05). One patient in group A had numbness and discomfort in the lower limb on the healthy side after surgery, and one case with mild dural tear in group B. Conclusions: Both unilateral decompression and bilateral decompression under OSE are safe and effective in the treatment of moderate and severe central canal and bilateral lateral recess stenosis with unilateral symptoms in the middle-aged and elderly people, with definite early clinical efficacy. Bilateral decompression is more complete and better in clinical efficacy than unilateral decompression, but further follow-up is required in the long term.