Clinical efficacy of ultrasonic osteotome assisted unilateral approach contralateral undercutting decompression in the treatment of severe degenerative lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Ultrasonic osteotome  Undercutting decompression

English Abstract:

  【Abstract】 Objectives: To investigate the effectiveness and safety of unilateral approach contralateral undercutting decompression assisted with ultrasonic osteotome in treating severe degenerative lumbar spinal stenosis. Methods: 174 patients with severe degenerative lumbar spinal stenosis who were treated with ultrasonic osteotome assisted unilateral approach contralateral undercutting decompression between June 2018 and June 2021 were collected[unilateral approach bilateral decompression transforaminal lumbar interbody fusion(TLIF) group, group A], and 129 patients undergone bilateral transforaminal decompression during the same period were randomly selected as control(bilateral small incision TLIF group, group B). The perioperative parameters such as incision length, operative time, intraoperative blood loss, postoperative drainage, and length of hospital stay were recorded and compared between the two groups. Creatine phosphokinase(CPK) test was performed to evaluate muscle damage conditions, and visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate the postoperative therapeutic effects. The complications and fusion conditions were compared between the two groups. Results: There wasn′t significant difference in average length of bilateral incisions and length of hospital stays between the two groups(P>0.05). Group A was less significantly than group B in terms of operative time, intraoperative blood loss, and postoperative drainage, with statistical significance(P<0.05). The preoperative CPK value was comparable between the two groups(P>0.05), and on postoperative 1d and 3d it was statistically greater in group B than in group A(P<0.05), but on postoperative 5d it wasn′t significantly different between the two groups(P>0.05). The postoperative VAS scores and ODI improved compared with the preoperative values in both groups on postoperative 3d, at 1 month, 3 months, and 12 months(P<0.05), and there was no statistical difference between the two groups respectively at the same follow-up period(P>0.05), even though group A was better in ODI and VAS than group B at 12 months after operation. There was no significant difference between the two groups in postoperative complications such as dural tear, incision fat liquefaction, cerebrospinal fluid leakage and postoperative infection. Group A was less in the proportion of postoperative worsening lower limb numbness and rebound of hip/lower limb symptoms than in group B(P<0.05). 1 year after operation, 12 cases in group A were not fused, and 8 cases in group B were not fused. There was no statistically significant difference in the bone graft fusion between the two groups(P>0.05). Conclusions: Comparing with bilateral small incision TLIF, ultrasonic osteotome assisted unilateral approach contralateral undercutting decompression also can achieve good treatment results, which features in less trauma, less effects on spinal stability, shorter operative time, and less intraoperative blood loss, and therefore worth in clinical promotion.