Comparison of curative effects of unilateral double-channel and single-channel spinal endoscopy assisted bilateral decompression in the treatment of lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Unilateral laminectomy and bilateral decompression  Unilateral biportal endoscopy

English Abstract:

  【Abstract】 Objectives: To compare the efficacies of unilateral biportal endoscopy(UBE) and percutaneous endoscopy(PE) assisted unilateral laminotomy for bilateral decompression(ULBD) in the treatment of lumbar spinal stenosis(LSS). Methods: The clinical data of 94 patients with LSS who underwent ULBD surgery in our hospital between June 2023 and June 2024 were retrospectively analyzed. The patients were divided into a control group(47 cases, PE-ULBD) and an observation group(47 cases, UBE-ULBD) according to different surgical auxiliary techniques. The perioperative indicators(including operative time, incision length, intraoperative blood loss, and bed rest and hospitalization time), imaging evaluation indexes[including the dural sac cross-sectional area(DSCA), decompression rate of approach side and contralateral side bony lateral recess(LR), decompression rate of ipsilateral and contralateral disc space, and resection angle of facet joint in the approach side], as well as low back pain and leg pain visual analogue scale(VAS) scores, Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, and the level of inflammatory reaction[interleukin-4(IL-4), IL-6, tumor necrosis factor-α(TNF-α)] before and after operation(3d, 1 month, 6 months) were compared between the two groups. The postoperative complications of the two groups were counted. Results: Compared with the control group, the operative time in the observation group was shorter and the total length of the incision was longer(P<0.05). The amount of blood loss, postoperative bed rest and hospitalization time in the two groups were similar(P>0.05). Compared with the control group, the DSCA, decompression rate of LR, decompression rate of ipsilateral and contralateral disc space in the observation group were higher on the 3rd postoperative day, and the resection angle of facet joint in the approach side was smaller(P<0.05). The low back pain and leg pain VAS scores in both groups decreased at postoperative 3d, 1 month and 6 months compared with preoperative values, and the observation group was lower than the control group at each postoperative time point(P<0.05). ODIs in both groups decreased at postoperative 1 month and 6 months compared with preoperative values, while JOA scores increased. Compared with the control group, the ODI in the observation group was lower at 1 month and 6 months after operation, and JOA score was higher(P<0.05). The levels of IL-4 in both groups at postoperative 3d were increased compared with before operation, and the levels of IL-6 and TNF-α were decreased(P<0.05). Compared with the control group, the levels of IL-4 in the observation group were higher, but the levels of IL-6 and TNF-α were lower(P<0.05). The incidence of postoperative complications in the observation group(4.26%) was not statistically significantly different compared with that in the control group(8.51%, P>0.05). Conclusions: Both UBE-ULBD and PE-ULBD techniques result in fewer postoperative complications and shorter hospitalization time in the treatment of LSS. PE-ULBD has a small surgical incision. However, UBE-ULBD offers superior benefits such as greater expansion of the DSCA, better preservation of facet joints on the approach side, more adequate decompression of the contralateral LR and disc-space, and relatively less interference to surrounding tissues. It can more effectively alleviate lumbocrural pain and systemic inflammatory response in patients, as well as improve lumbar spine function.