Purpose

Full-endoscopic spine surgery for degenerative lumbar diseases is growing in popularity and has shown favourable outcomes. Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been used to treat lumbar spinal stenosis (LSS). However, studies comparing LE-ULBD to microscopic ULBD are lacking. This study compared the clinical efficacy and radiological outcomes between the LE-ULBD and microscopic ULBD.

Methods

The study retrospectively enrolled patients undergoing either LE-ULBD or microscopic ULBD for spinal stenosis at the L4–L5 level. The demographic data, operative details, radiological images, clinical outcomes, and complications of patients from the two groups were compared through matched-pairs analysis. The minimum follow-up duration was 24 months.

Results

There were 93 patients undergoing either LE-ULBD (n = 42) or microscopic ULBD (n = 51). The patient demographics were similar between the two groups. The LE-ULBD group had significantly less estimated blood loss, less analgesic use, and shorter hospitalization duration (P < .05). The endoscopic group had a significantly lower visual analog scale for back pain at all follow-up intervals compared with the microscopic group (P < .05). There were no significant differences in leg pain or Oswestry Disability Index. The cross-section area of the spinal canal was significantly wider after microscopic ULBD. There were no significant differences in post-operative degenerative changes in disc height, translational motion, or facet preservation rate.

Conclusions

LE-ULBD is comparable in clinical and radiological outcomes with enhanced recovery for single-level LSS. The endoscopic approach might further minimize tissue injury and enhance post-operative recovery.

中文翻译：

---

全内镜与显微单侧椎板切开术双侧减压 L4-L5 腰椎管狭窄症：比较研究

目的

用于退行性腰椎疾病的全内窥镜脊柱手术越来越受欢迎，并显示出良好的效果。用于双侧减压的腰椎内窥镜单侧椎板切开术 (LE-ULBD) 已用于治疗腰椎管狭窄症 (LSS)。然而，缺乏将 LE-ULBD 与显微 ULBD 进行比较的研究。本研究比较了 LE-ULBD 和显微 ULBD 的临床疗效和放射学结果。

方法

该研究回顾性地招募了因 L4-L5 椎管狭窄而接受 LE-ULBD 或显微 ULBD 的患者。通过配对分析比较两组患者的人口统计学资料、手术细节、影像学、临床结果和并发症。最短随访时间为 24 个月。

结果

有 93 名患者接受了 LE-ULBD（n  = 42）或显微 ULBD（n  = 51）。两组患者的人口统计数据相似。LE-ULBD 组的估计失血量、镇痛剂使用量和住院时间均显着减少 ( P  < .05)。与显微镜组相比，内窥镜组在所有随访时间间隔内的背痛视觉模拟量表均显着降低（P < .05)。腿痛或 Oswestry 残疾指数没有显着差异。显微 ULBD 后椎管的横截面积明显变宽。椎间盘高度、平移运动或小面保留率的术后退行性变化没有显着差异。

结论

LE-ULBD 在临床和放射学结果方面具有可比性，单节段 LSS 恢复更快。内窥镜方法可能会进一步减少组织损伤并促进术后恢复。