Clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression in the treatment of lumbar spinal stenosis under local anesthesia

English Keywords:Lumbar spinal stenosis  Local anesthesia  Unilateral biportal endoscopy  Unilateral laminotomy for bilateral decompression

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression(ULBD) in the treatment of lumbar spinal stenosis under local anesthesia, and to compare the anesthetic effects of single-stage and two-stage local anesthesia. Methods: A retrospective analysis was conducted on the data of 106 patients with lumbar spinal stenosis who underwent unilateral biportal endoscopy assisted ULBD treatment under local anesthesia in our hospital from January 2022 to June 2023. There were 51 males and 55 females, aged 55-83(66.7±14.5) years old, with the following lesion segments: 17 cases at L3-4, 36 cases at L4-5, and 53 cases at L5-S1. Schizas classification: 25 cases of grade B, 36 cases of grade C, and 45 cases of grade D. Among them, 52 patients underwent single-stage local anesthesia and were included in the single anesthesia group(Group A), while 54 patients received two-stage local anesthesia and were included in the two-stage local anesthesia group(Group B). There were no statistically significant differences in age, gender ratio, body mass index(BMI), surgical segments, Schizas classification and American Society of Anesthesiologists(ASA) classification between the two groups of patients. The perioperative complications, operative time, as well as the visual analogue scale(VAS) score, oxygen saturation, mean arterial pressure, heart rate in both groups before surgery(T1), during exposure(T2), during traction of the nerve root(T3), and immediately after surgery(T4) were recorded; The VAS scores for low back pain and leg pain, as well as the Oswestry disability index(ODI), were compared between the two groups before and after surgery. The MacNab assessment criteria were used to evaluate the overall postoperative efficacy of the patients at the final follow-up. Results: All patients successfully completed the operation. Two cases had dural tear, but no dural repair was performed; Five cases had mild headache, which disappeared after symptomatic treatment; Four cases had increased lower limb pain and numbness compared to pre-operative conditions, which were treated with symptomatic treatment for swelling reduction, and the symptoms alleviated or disappeared 3-5d after surgery; All incisions healed in stage I. During the operation, the vital signs remained stable throughout and no unexpected incidents occurred. There was no statistical difference between group A and group B in operative time(101.9±17.3min vs. 103.6±15.9min, P>0.05). No statistically significant difference was observed in VAS scores, mean arterial pressure and heart rate between the two groups at T1 and T2(P>0.05). At T3 and T4, the VAS scores, mean arterial pressure and heart rate of group A were significantly higher than those of group B(P<0.05). At each time point after surgery, the VAS scores and ODI of the two groups improved significantly compared with those before surgery(P<0.05), but there was no statistically significant difference between the two groups at the same time point(P>0.05). At the final follow-up, 31 cases in group A were excellent, 14 cases were good, and 7 cases were fair, with an excellent and good rate of 86.5%; 36 cases in group B were excellent, 13 cases were good, and 5 cases were fair, with an excellent and good rate of 90.7%. There was no statistically significant difference in the excellent and good rate between the two groups(P>0.05). Conclusions: The unilateral biportal endoscopy technique under local anesthesia for ULBD in the treatment of lumbar spinal canal stenosis can achieve good clinical efficacy, and two-stage local anesthesia provides a superior analgesic effect compared to single-stage local anesthesia. This method holds significant clinical application value, particularly for patients with lumbar spinal canal stenosis accompanied by complex comorbidities and at high risk for general anesthesia.