| Objective:To compare the clinical efficacy of unilateral biportal endoscopy(UBE)to laminectomy with fusion and internal fixation(posterior lumbar interbody fusion,PLIF)in the treatment of severe lumbar spinal stenosis(SLSS).Methods:Data of 64 patients with SLSS treated with UBE or PLIF in Dalian Municipal Central Hospital from April 2018 to April 2021 were were retrospectively analyzed,males/females(27/37).The age was(69.5±6.5)years(ranging from 57 to 83 years).According to the surgical method,30 patients were divided into UBE group,males/females(12/18),age was(69.8±6.8)years(ranging from 57 to 83 years).PLIF group included 34 patients,males/females(15/19),age was(69.3±6.3)years(ranging from 59 to 81 years).The operation time,post-operative bed rest time,surgical complications,intraoperative blood loss,the volume of drainage,transfusion,postoperative hospital stay,surgical costs of both groups were recorded and analyzed.The visual analogue scales(VAS)of back/leg pain(pre-operation and 1 day,1 month,6 momths,1-year post-operation)and Oswestry disability index(ODI)(pre-operation and 1 day,6 months,1-year post-operation)were used to determine the outcome.And the dural sac cross-sectional area(DSCA)and Schizas grade under magnetic resonance imaging of both groups preoperatively and postoperatively were recorded.Results:All patients underwent successful surgery.In UBE group,the operative time was(69.2±8.0)min,post-operative bed rest time was(1.8±0.7)days and postoperative hospital stay was(3.0±0.9)days.PLIF groups was(139.0±15.3)min,(4.5±1.4)days and(7.1 ± 1.7)days,respectively.The difference was statistically significant(t=23.19,P<0.001;t=-10.35,P<0.001;t=-12.46,P<0.001).The intraoperative blood loss was(19.5±5.6)ml,the volume of drainage was(15.0±10.8)ml,transfusion rate was 0%,in UBE group.PLIF groups was(212.4±34.1)ml,(169.6±43.8)ml and 17.6%,respectively,the difference was statistically significant(t=-32.48,P<0.05;t=-19.89,P<0.05;t=-2.66,P<0.05).The surgical cost was lower in the UBE group than in the PLIF group(t=-34.99,P<0.05).In UBE group,the VAS of back pain decreased from(7.10±1.09)points before surgery to(3.27±0.52)points at postoperative 1 day,(2.67±0.61)points at postoperative 1 month,(1.80±0.55)points at postoperative 6 months and(1.27±0.45)points at postoperative 1 year.The VAS of leg pain decreased from(7.97±0.67)points before surgery to(3.33±0.80)points at postoperative 1 day,(2.20±0.55)points at postoperative 1 month,(1.43±0.50)points at postoperative 6 months and(1.13±0.35)points at postoperative 1 year.The postoperative VAS of back and leg pain was improved compared with that before surgery,and the difference was statistically significant(F=417.558,P<0.001;F=899.977,P<0.001).In PLIF group,the VAS of back pain decreased from(6.97±0.97)points before surgery to(6.26±0.75)points at postoperative 1 day,(2.94±0.60)points at postoperative 1 month,(2.06±0.65)points at postoperative 6 months and(1.44±0.50)points at postoperative 1 year.The VAS of leg pain decreased from(7.82 ± 0.80)points before surgery to(3.53 ±0.71)points at postoperative 1 day,(2.26±0.67)points at postoperative 1 month,(1.56±0.50)points at postoperative 6 months and(1.24±0.43)points at postoperative 1 year.The VAS of back pain was not significantly improved 1 day after surgery(t=2.512,P=0.135),but improved 1 month,6 months and 1 year after surgery compared with that before surgery.The postoperative VAS of leg pain was improved compared with that before surgery,and repeated measurement analysis of VAS of back and leg pain were statistically significant(F=543.872,P<0.001;F=685.315,P<0.001).The VAS of back pain of the UBE group was lower than that of the PLIF group 1 day after surgery,the difference was statistically significant(t=-20.646,P<0.001),but there was no statistically significant difference between the two groups 1 month after surgery(t=-1.817,P<0.074).The ODI of UBE group decreased from 68.13%±7.33%before surgery to 31.53%±4.09%at postoperative 1 month,68.13%±7.33%at postoperative 6 months and 12.40%± 3.17%at postoperative 1 year.The ODI of PLIF group decreased from 69.06%±7.74%before surgery to 46.00%±5.12%at postoperative 1 month,26.35%±3.53%at postoperative 6 months and 14.29%±3.08%at postoperative 1 year.The postoperative ODI of two groups were improved compared with the preoperative ODI,and the difference was statistically significant（F=1410.570,P<0.001;F=1120.660,P<0.00).At 1 month after surgery,the ODI of the UBE group was better than that of the PLIF group,the difference was statistically significant(t=-12.379,P<0.001),but there was no statistically significant difference at 6 months after surgery(t=-1.210,P=0.231).In UBE group,the dural sac area was(45.13±11.82)mm2 before surgery and(129.20± 15.73)mm2 after surgery.In PLIF group,the dural sac area was(49.97±10.30)mm2 before surgery and(152.53±12.73)mm2 after surgery.The dural sac area of the two groups was improved after surgery,and the difference was statistically significant(t=23.399,P<0.001;t=36.510,P<0.001).There was no statistically significant difference between the two groups(t=-1.75,P=0.085),but there was statistically significant difference after surgery(t=-6.55,P<0.001).In UBE group,the Schizas grade C was 17 cases and grade D was 13 cases before surgery.Grade A was 25 cases and grade B was 5 cases after surgery.In the PLIF group,grade C was 18 cases and grade D was 16 cases before surgery,grade A was 30 cases and grade D was 5 cases after surgery.The Schizas was no statistical significance before and after surgery(P=0.77,P=0.57).Conclusion:UBE could achieve full decompression of the whole spinal canal with limited structures damage to treat SLSS.Compared traditional open laminectomy decompression with fusion and fixation,UBE-ULBD could got complete decompression as well as less iatrogenic damage.The UBE-ULBD may be an ideal alternative surgical technique for SLSS treatment with less invasion. |
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