Comparison of effectiveness between unilateral and bilateral biportal endoscopy decompression in treatment of two-level central lumbar spinal stenosis
10.3760/cma.j.cn115396-20250116-00014
- VernacularTitle:单侧和双侧双通道内镜椎管减压治疗双节段中央型腰椎管狭窄症的疗效比较
- Author:
Xuanchen ZHU
1
;
Zhiwen SONG
;
Jiajun ZHU
;
Jinbo LIU
;
Jun WU
Author Information
1. 常州市第一人民医院脊柱外科，常州 213003
- Keywords:
Spinal stenosis;
Decompression;
Spinal diseases;
Spinal endoscopy;
Spinal degeneration
- From:
International Journal of Surgery
2025;52(7):449-455
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the effectiveness between the unilateral biportal endoscopy (UBE) and the bilateral biportal endoscopy (BBE) decompression in the treatment of two-level central lumbar spinal stenosis (LSS).Methods:From January 2022 to April 2024, the clinical data of 31 patients with two-level central LSS treated with UBE and BBE unilateral approach with bilateral decompression were retrospectively analyzed. There were 17 males and 14 females; the age ranged from 60 to 82 years, with a mean of (71.2±5.9) years. The operative segments were L 2-3 and L 3-4 in 2 cases, L 3-4 and L 4-5 in 29 cases. Among them, 15 cases were treated with UBE and the other 16 cases were treated with BBE. The age, gender, course of disease, operation time, intraoperative fluoroscopy frequency, ambulation time, hospitalization days, incision healing grade and surgical complications were compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the low back and leg pain degree and functional improvement situation before operation, 3 months after operation and at last follow-up. Imaging examinations were performed before and after operation to evaluate the height of intervertebral space, the rate of articular process preservation and the area of dural sac in the two groups. Measurement data with normal distribution were represented as mean±standard deviation( ± s), and the comparison between groups was conducted using the t-test; measurement data with skewed distribution were represented as (interquartile range) [ M( Q1, Q3)], inter-group comparisons were conducted using the two-sample rank sum test, and intra-group comparisons before and after surgery were conducted using the rank sum test for two related samples or the rank sum test for multiple related sample data. The count data were represented as cuses and percentages, and the comparison between groups was conducted using the Chi-square test or Fisher exact probability method. Results:Thirty-one patients were successfully operated and followed up for 6-18 months, with an average follow-up time of (11.4±3.2) months. There was no significant difference in age, gender, course of disease, ambulation time and hospitalization days between the two groups ( P>0.05). There were significant differences between UBE and BBE in fluoroscopy frequency [(4.2±0.7) vs (2.3±0.4)] and operation time [(118.2±12.8) min vs (72.3±5.6) min] ( P<0.001). Three months after operation and at last follow-up, the VAS scores and ODI were significantly lower than that befor the operation, and the dural sac area was significantly larger than that before the operation in the two groups ( P<0.001), but there was no significant difference in VAS, ODI and dural sac area before or after operation between the two groups ( P>0.05). There was no statistical difference in the intervertebral height between the two groups compared to their respective preoperative measurements( P>0.05). The rate of articular process preservation on the operated side was about 80% in both groups. There were no complications such as dural nerve injury and hemorrhage in both groups. One patient in the UBE group had incision infection, which was improved after symptomatic treatment. Conclusions:Both UBE and BBE can achieve satisfactory effectiveness in the treatment of two-level central LSS, and the clinical effectiveness is similar. BBE can improve the operation efficiency, shorten the surgical duration and reduce the fluoroscopy frequency, so it has more advantages in the treatment of two-level central LSS.
