The Comparative Study Of Learning Curves And Clinical Efficacy Of Unilateral Biportal Endoscopy And Percutaneous Endoscopic Transforaminal Discectomy For Treatment Of Lumbar Disc Herniation

Objective(s):The purpose of this study was to investigate the Learning curve differences between unilateral biportal endoscopy(UBE)and percutaneous endoscopic transforaminal discectomy(PETD)in the treatment of lumbar disc herniation(LDH).Method(s): A retrospective analysis was conducted to assess from July2019 to January 2022,the same surgeon in our hospital treated 66 patients with lumbar disc herniation through posterior approach UBE technique and PETD technique respectively in the early stage.There were 52 males and 14 females in the PETD group,with an average age of 46.91 years(19-82 years),and 49 males and 17 females in the UBE group.The mean age was 46.83 years(20-79 years).The two groups of patients were arranged according to the time sequence of receiving surgical treatment,and the surgical process was divided into three key technical steps: channel establishment,surgical field exposure and decompression.operation time,each key step time,intraoperative blood loss,complications,VAS and ODI scores of each group were collected and evaluated before and after 1 month and the last follow-up to compare the clinical effect.The learning curve of each key step time was compared.The learning curve of operation time was studied using a CUSUM method.The cut-off point and the change trend of the learning curve was obtained.Result(s):(1)There were no significant differences between the two groups at gender,age,surgical protrusion segment and type,preoperative lumbago VAS,ODI score,lumbago VAS score and improvement value one month post surgery,and the time to establish the channel(P>0.050).(2)Because the operation time in the learning period did not conform to the normal distribution,the operation time was compared with the median.The operative time of UBE group(105.00 min)<PETD group(135.00 min),the operative field exposure time of UBE group(43.00 min)>PETD group(40.30 min),and the decompression time of UBE group(34.00 min)<PETD group(50.00min),the pairwise differences of the above indicators were statistically significant(P <0.050*).Intraoperative blood loss in UBE group(58.10 ± 16.40ml)>PETD group(15.30 ± 10.70ml),(P<0.010**),the intraoperative fluoroscopy times were significantly less than those in PETD group(P< 0.010**).There were no significant differences in length of hospital stay and incidence of complications between the two groups(P>0.050).CUSUM learning curve k value was negative in 24 /42 patients in UBE and PETD groups respectively.Conclusion(s): The comparison of the learning curve of the two operations showed that UBE was able to cross the learning curve in 24 patients with lumbar disc herniation,while PETD was able to cross the learning curve in 42 patients.Compared with percutaneous endoscopic transforaminal discectomy,unilateral double-channel endoscopic technique has the advantages of short learning period and high decompression efficiency.