Comparative Study Of Clinical Efficacy Between UBE-ULBD And PE-ULBD In The Treatment Of Lumbar Spinal Stenosis

ObjectiveDegenerative lumbar spinal stenosis has become a common clinical disease,and millions of people suffer from it worldwide.Surgical intervention is required for patients with severe or progressive neurological injury,persistent pain and ineffective conservative treatment.Among traditional treatment methods,open surgery is the most commonly used Surgical methods.However,the larger iatrogenic trauma will have a negative impact on the anatomical tissues such as muscles and ligaments.With the introduction of the concept of minimally invasive surgery in spinal surgery,minimally invasive methods such as microdiscectomy and microendoscopic discectomy have emerged.With the development of science and technology,the appearance of spinal endoscopy has opened up a new technical means for the treatment of lumbar diseases.However,the spinal surgeon found that unilateral spinal canal decompression is no longer suitable for patients with bilateral limb symptoms,so they proposed unilateral laminotomy for bilateral decompression(ULBD)for central spinal stenosis and bilateral nerve root canal stenosis and other diseases technology.At present,ULBD technology has been used in single portal endoscopic spine surgery,which was known as Percutaneous Endoscopic Unilateral Laminectomy for Bilateral Decompression(PE-ULBD),and many clinical studies have confirmed its safety and effectiveness.However,the spine surgeon found that a single portal needs to pass through a light source,a visualization probe,and special instruments for endoscopy.The intraoperative operation and the field of vision will be limited,and patients with lateral recess stenosis may not be fully decompressed.Therefore,some scholars have proposed to use double portals instead of single portal to treat lumbar disc herniation and lumbar spinal stenosis,and called it Unilateral Biportal Endoscopic Spine Surgery(UBE-ULBD).It has attracted the interest of many spine surgeons,but there is still no strong research on its surgical effect.The purpose of this study is to compare the efficiency,operation difficulty and postoperative effect of UBE-ULBD and PE-ULBD(43mm diameter)inthe treatment of lumbar spinal stenosis.Conclusion to guide the choice of clinical operation.MethodsWe selected 20 patients who met the later standards From January 2018 to January2020 from our hospital.There were 11 males and 9 females with an average age of 64.9± 8.23 years.The operation was performed by the same senior surgeon with mature spinal endoscopy technology in our hospital.Before operation,the patients should complete the X-ray,CT,MRI and other related examinations of the lumbar spine,and make sure that the segments and types of the lesions meet the test standard.The subjects were randomly divided into two groups by using the software of computer digital random generation.The patients in the above 2 groups were subjected to prone position surgery under general anesthesia.The main operation time,postoperative hospital stay,total incision length,intraoperative and postoperative complications,VAS,ODI and macnab scores of the patients’ back and lower limbs before and 1 day and 3 months after operation were recorded.The increased cross-sectional area of dural sac expansion was measured during postoperative CT.ResultsAll the operations were successfully completed.One patient in each group had complications of dural sac tears during the operation.After the operation,the corresponding measures such as fluid replacement and anti infection were taken in time to recover well without other adverse symptoms.The VAS pain score and ODI score of lumbar back and lower limbs in the two groups were significantly reduced at 1 day and3 months after operation of follow-up,which proved that the two kinds of operation were feasible and effective in the treatment of lumbar spinal stenosis,but there was no statistical difference between the two groups of data,indicating that the two methods had no significant difference in the effect of the conventional treatment.There was a significant difference in the length of the surgical incision between the two groups of patients.Because the UBE-ULBD was has one more working portal than PE-ULBD.The length of hospital stay was not statistically significant in the two groups.The increase of the most narrow cross-sectional area was measured on CT images before and after operation in the two groups,and the cross-sectional expanded area term p <0.05 after statistical examination,proves that there is a significant difference between the 2 groups.Among them,the cross-sectional area of dural sac in UBE group increased more,whichproved that the decompression range in operation was wider than that in ULBD group.ConclusionThis clinical study shows that UBE-ULBD and uniportal PE-ULBD are both effective surgical methods for the treatment of patients with degenerative lumbar spinal stenosis.But UBE-ULBD technology has higher decompression efficiency and clearer vision,which can complete bilateral decompression of the spinal canal more thoroughly and has a wider decompression range.