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Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note
Clinical Interventions in Aging ( IF 3.5 ) Pub Date : 2024-01-06 , DOI: 10.2147/cia.s443792 Tong Wu 1 , Da Liu 1 , Fanhe Meng 1 , Jing-Han Lu 1 , Yi-Feng Chen 1 , Zheng Fan 1
Clinical Interventions in Aging ( IF 3.5 ) Pub Date : 2024-01-06 , DOI: 10.2147/cia.s443792 Tong Wu 1 , Da Liu 1 , Fanhe Meng 1 , Jing-Han Lu 1 , Yi-Feng Chen 1 , Zheng Fan 1
Affiliation
Purpose: Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients.
Patients and Methods: This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system.
Results: UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41± 1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study.
Conclusion: Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.
Keywords: awake spinal surgery, local anesthesia, degenerative lumbar disease, biportal endoscopic spine surgery, enhanced recovery after surgery
中文翻译：
局麻下清醒单侧双孔内镜减压治疗老年人退变性腰椎管狭窄症：可行性研究及技术说明
目的：在这里，我们介绍一种清醒单侧双门内镜（UBE）减压的新策略，该策略应用清醒镇静结合逐步局部麻醉（LA）作为全身麻醉（GA）的替代方案。该研究旨在评估清醒UBE减压治疗老年退行性腰椎管狭窄症（DLSS）的可行性。
患者和方法：这项回顾性研究包括 2021 年 1 月至 2022 年 3 月在我们机构接受清醒 UBE 减压治疗 DLSS 的连续 31 名患者。使用患者报告的结果测量 (PROM) 评估临床结果，包括腿部疼痛视觉模拟量表 (VAS) -LP)、Oswestry 残疾指数 (ODI) 和修改后的 MacNab 标准。通过术中VAS和满意度评分系统评价麻醉效果和术中体验。
结果：所有患者在LA联合清醒镇静下均成功进行UBE减压。 26 名（83.9%）患者对术中体验评价为满意（优秀或良好），5 名（16.1%）患者评价为一般。术中平均 VAS 为 3.41±1.26。术后各随访阶段的 VAS 和 ODI 评分均较术前显着改善（ p < 0.01）。在末次随访时，28 名患者（90.3%）将手术结果评为良好或优秀，3 名患者（9.7%）将手术结果评为一般。研究中未观察到严重并发症或不良反应。
结论：我们的初步结果表明，清醒 UBE 减压对于老年 DLSS 患者来说是一种可行且有前景的替代方案。
Keywords:清醒脊柱手术, 局部麻醉, 退变性腰椎疾病, 双孔内镜脊柱手术, 加速康复外科
更新日期：2024-01-06
Patients and Methods: This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system.
Results: UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41± 1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study.
Conclusion: Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.
Keywords: awake spinal surgery, local anesthesia, degenerative lumbar disease, biportal endoscopic spine surgery, enhanced recovery after surgery
中文翻译：
局麻下清醒单侧双孔内镜减压治疗老年人退变性腰椎管狭窄症：可行性研究及技术说明
目的：在这里，我们介绍一种清醒单侧双门内镜（UBE）减压的新策略，该策略应用清醒镇静结合逐步局部麻醉（LA）作为全身麻醉（GA）的替代方案。该研究旨在评估清醒UBE减压治疗老年退行性腰椎管狭窄症（DLSS）的可行性。
患者和方法：这项回顾性研究包括 2021 年 1 月至 2022 年 3 月在我们机构接受清醒 UBE 减压治疗 DLSS 的连续 31 名患者。使用患者报告的结果测量 (PROM) 评估临床结果，包括腿部疼痛视觉模拟量表 (VAS) -LP)、Oswestry 残疾指数 (ODI) 和修改后的 MacNab 标准。通过术中VAS和满意度评分系统评价麻醉效果和术中体验。
结果：所有患者在LA联合清醒镇静下均成功进行UBE减压。 26 名（83.9%）患者对术中体验评价为满意（优秀或良好），5 名（16.1%）患者评价为一般。术中平均 VAS 为 3.41±1.26。术后各随访阶段的 VAS 和 ODI 评分均较术前显着改善（ p < 0.01）。在末次随访时，28 名患者（90.3%）将手术结果评为良好或优秀，3 名患者（9.7%）将手术结果评为一般。研究中未观察到严重并发症或不良反应。
结论：我们的初步结果表明，清醒 UBE 减压对于老年 DLSS 患者来说是一种可行且有前景的替代方案。
Keywords:清醒脊柱手术, 局部麻醉, 退变性腰椎疾病, 双孔内镜脊柱手术, 加速康复外科
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