Preliminary Study Of Unilateral Biportal Endoscopic Lumbar Interbody Fusion For Lumbar Spinal Stenosis

Objective:To evaluate the clinical and imaging efficacy of unilateral biportal endoscopic lumbar interbody fusion(ULIF)for the treatment of lumbar spinal stenosis.Methods:Retrospective analysis of 65 patients with single-segment lumbar spinal stenosis admitted and surgically treated from March 2019 to March 2021 at our hospital.Among them,29 patients were treated by unilateral biportal endoscopic lumbar interbody fusion(ULIF group)and 36 patients were treated by minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF group).Clinical and imaging indicators were collected in both groups,including operative time,intraoperative bleeding,postoperative hospital stay,operative complications,preoperative,1 week postoperative,3 months postoperative,and 1 year postoperative follow-up visual analogue scale(VAS)of low back pain and leg pain and Oswestry disability index(ODI),as well as the modified Macnab score at the last follow-up;imaging indexes included preoperative Schizas classification,improvement rate of spinal canal area,and fusion rate at the last follow-up.The clinical and imaging efficacy of the two techniques were analyzed and compared.Results:All patients completed the surgery successfully.the mean follow-up time was(17.83±4.27)months in the ULIF group and(18.33±3.91)months in the MIS-TLIF group.Compared with the MIS-TLIF group,the ULIF group had less intraoperative bleeding and shorter postoperative hospital stay,but longer operative time,with statistically significant differences(P<0.05).The postoperative VAS score and ODI of both groups decreased significantly compared with those before surgery(P<0.05),and the VAS score and ODI of low back pain in the ULIF group decreased more significantly than those in the MIS-TLIF group 1 week after surgery,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the improvement rate of spinal canal area between the two groups after surgery(P>0.05).The fusion rate was 89.7%in the ULIF group and 88.9%in the MIS-TLIF group at the final follow-up,and the difference between the two groups was not statistically significant(P>0.05).The excellent rate of modified MacNab criteria at the final follow-up was 93.1%in the ULIF group and 91.7%in the MIS-TLIF group,and the difference was not statistically significant(P>0.05).The postoperative complication rate was 10.34%in the ULIF group and 8.33%in the MIS-TLIF group,and the difference was not statistically significant(P>0.05).Conclusion:1.The ULIF technique has the advantages of less intraoperative bleeding,less early postoperative lumbar pain,shorter postoperative hospital stay,faster early functional recovery,and bilateral spinal canal decompression can be accomplished with a unilateral approach,which can effectively improve the spinal canal area.2.Both the ULIF procedure and MIS-TLIF yield ideal clinical outcomes,with no significant differences between the two techniques in terms of fusion rates and complications,but the ULIF procedure takes longer.Physicians with a foundation in endoscopy who master ULIF have the potential to make it one of the mainstream minimally invasive spine procedures to replace MIS-TLIF.