Comparison Of The Efficacy Of Unilateral Lamionmyfor Bilateral Decompression Between UBE And UE In The Treatment Of Lumbar Spinal Stenosis

Objective: The aim of this study was to compare the short-term outcomes of unilateral laminotomy and bilateral decompression under unilateral biportal endoscopy(UBE)and single-channel endoscopy(UE)in the treatment of lumbar spinal stenosis.To explore the feasibility of unilateral laminotomy and bilateral decompression under UBE in the treatment of lumbar spinal stenosis based on the differences in clinical efficacy and imaging.Methods: The patients with lumbar spinal stenosis from December2019 to December 2021 were collected and treated with ULBD for unilateral double-channel spinal endoscope and single-channel spinal endoscope.They were divided into two groups according to the different use of surgical endoscope.We calculated the hospital stay,Operation time,postoperative complications,preoperative and postoperative JOA and ODI scores of the two groups of patients(1 week,3 months,6months and 12 months after the operation).(1)The area of dural sac of lumbar MRI before and 3 monthsafter operation was counted;(2)The width of the upper articular process on both sides of the lumbar CT disc yellow space and the distance from the inner edge of the upper articular process on both sides of the bony lateral recess to the inner wall of the pedicle were counted before and 48 hours after operation,and the decompression rate of the nerve root canal andnarrow length of disc yellow spacewas calculated.(2)The percentage of facet joint surface retention was used to compare and evaluate the clinical efficacy and prognosis of two kinds of spinal endoscopes.Results: All patients were followed up for 12 months by telephone and outpatient follow-up.The average operation time of UBE group was123(120,125)minutes,while that of UE group was 120.5(120,123)minutes,and there was no significant difference between the two groups(P > 0.05).The average hospitalization time of UBE group was 6(5,7)days,while that of UE group was 6(5,7)days,and there was no significant difference between the two groups(P > 0.05).There was no significant difference in JOA and ODI between the two groups before operation,one week、3months、6months、12 months afteroperation(P> 0.05).There was 1 case of transient numbness of lower limbs,2 cases of dural tear,1caseof fever in UBE group,1case of dural tear,2caseof fever and 1 case of postoperative epidural hematoma in UE group.There was no significant difference in the incidence of postoperative complications between the two groups(P > 0.05).The average dural sac area of postoperative lumbar MRI in UBE group was significantly larger than that in UE group,and there was no significant difference between the two groups(P < 0.05).The decompression rate of bilateral nerve root canals in UBE group was better than that in UE group,and there was significant difference between the two groups(P < 0.05).Intra-group comparison: JOA and ODI scores of patients in the two groups were significantly higher than those before operation 1 week、3 months 、6months 、 12 monthsafter operation(p < 0.05);The average dural sac area of the two groups after operation was significantly larger than that before operation(P < 0.05).The decompression rate of nerve root canals in UBE group was not significantly different from that in the contralateral group(P > 0.05),while that in UE group was significantly higher than that in contralateral group(P < 0.05).Conclusion:In this study,both unilateral dual-channel spinal endoscopy and single-channel spinal endoscopy for ULBD can achieve relatively ideal clinical results.The two groups of patients have short operation time,less intraoperative blood loss,small incision trauma,and postoperative recovery.However,there are still some differences in the radiological results of the two procedures.The decompression range of the bilateral recesses of UBE is wider,especially the contralateral recesses,and the decompression efficiency is higher and more sufficient;the dural sac dilatation is more obvious after UBE;UBE preserves the facet joint surface to the greatest extent and reduces the damage of the ipsilateral facet joint,which is of great significance for maintaining the structural stability of the back of the spine;in addition,UBE has a greater degree of visualization and more instrument use than UE during the operation.flexible.A unilateral dual-channel endoscopic system may be an effective treatment for lumbar spinal stenosis and an alternative to traditional endoscopic surgery.