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Feng Z, Zhao Z, Cui W, Meng X, Hai Y. Unilateral biportal endoscopic discectomy versus microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2139-2153. [PMID: 38388729 DOI: 10.1007/s00586-023-08116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 02/24/2024]
Abstract
PURPOSE This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH). METHODS A comprehensive literature search was conducted in the Embase, PubMed, Cochrane Library, CNKI, and Web of Science databases from database inception to April 2023 to identify studies comparing UBED and MD for treating LDH. This study evaluated the visual analog scale (VAS) score, Oswestry disability index (ODI), Macnab scores, operation time, estimated blood loss, hospital stay, and complications, estimated blood loss, visual analog scale (VAS) score, Oswestry disability index (ODI), and Macnab scores at various pre- and post-surgery stages. The meta-analysis was performed using RevMan 5.4 software. RESULTS The meta-analysis included 9 distinct studies with a total of 1001 patients. The VAS scores for low back pain showed no significant differences between the groups at postoperative 1-3 months (P = 0.09) and final follow-up (P = 0.13); however, the UBED group had lower VAS scores at postoperative 1-3 days (P = 0.02). There were no significant differences in leg pain VAS scores at baseline (P = 0.05), postoperative 1-3 days (P = 0.24), postoperative 1-3 months (P = 0.78), or at the final follow-up (P = 0.43). ODI comparisons revealed no significant differences preoperatively (P = 0.83), at postoperative 1 week (P = 0.47), or postoperative 1-3 months (P = 0.13), and the UBED group demonstrated better ODI at the final follow-up (P = 0.03). The UBED group also exhibited a shorter mean operative time (P = 0.03), significantly shorter hospital stay (P < 0.00001), and less estimated blood loss (P = 0.0002). Complications and modified MacNab scores showed no significant differences between the groups (P = 0.56 and P = 0.05, respectively). CONCLUSION The evidence revealed no significant differences in efficacy between UBED and MD for LDH treatment. However, UBED may offer potential benefits such as shorter hospital stays, lower estimated blood loss, and comparable complication rates.
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Affiliation(s)
- Zihe Feng
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Zhiheng Zhao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Xianglong Meng
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China.
| | - Yong Hai
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China.
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Yin J, Ma T, Gao G, Chen Q, Nong L. Early Clinical and Radiologic Evaluation of Unilateral Biportal Endoscopic Unilateral Laminotomy and Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38442912 DOI: 10.1055/a-2281-2135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis. METHODS Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation. RESULTS The VAS for back and leg pain improved from 7.24 ± 0.80 and 7.59 ± 0.59 preoperatively to 2.41 ± 0.55 and 2.37 ± 0.62 (p < 0.05) postoperatively and 1.37 ± 0.54 and 1.51 ± 0.55 at the last follow-up (p < 0.05). For ODI, improvement from 60.37 ± 4.44 preoperatively to 18.90 ± 4.66 (p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 ± 87.81 to 232.97 ± 88.42 mm (p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 ± 3.13 and 19.57 ± 3.80 to 22.19 ± 4.56 and 21.04 ± 3.72 mm, respectively (p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 ± 1.12 and 3.20 ± 1.14 mm preoperatively and 4.03 ± 1.37 and 3.83 ± 1.32 mm (p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively. CONCLUSION The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.
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Affiliation(s)
- Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Tao Ma
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Gongming Gao
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Qi Chen
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Luming Nong
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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Jia D, Qiao X, Wang X, Li S, Li Q, Hao Y, Peng X. Early efficacy observation of the unilateral biportal endoscopic technique in the treatment of multi-level lumbar spinal stenosis. J Orthop Surg Res 2024; 19:117. [PMID: 38310279 PMCID: PMC10838451 DOI: 10.1186/s13018-024-04575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/22/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND To explore the early curative effect of unilateral biportal endoscopy (UBE) in the treatment of multi-level lumbar spinal stenosis with the help of multiple small incisions. METHODS A retrospective analysis was performed on 26 patients with multi-level lumbar spinal stenosis treated by UBE in our hospital from August 1, 2021, to March 1, 2022. We collect patients' basic medical records and independently design surgical incisions. The visual analog score (VAS) and Oswestry Disability Index (ODI) were compared before surgery, 7 days after surgery and 6 months after surgery. Spinal canal diameters on CT were compared before surgery and 7 days after surgery. The modified MacNab standard was used to evaluate the efficacy satisfaction at 6 months after operation. RESULTS In this study, 26 patients were operated according to the predetermined surgical plan. The operative time was 145 ± 40.11 min, the intraoperative blood loss was 156.25 ± 44.32 ml, and the postoperative hospital stay was 4.79 ± 1.31 days. The VAS scores of postoperative lumbago and leg pain were lower than those before surgery (P < 0.05). The postoperative ODI score was significantly different from that before surgery (P < 0.05). The postoperative CT sagittal diameter was significantly different from that before surgery (P < 0.05). The curative effect of modified MacNab was 76.92% when followed up 7 days after surgery. The curative effect of modified MacNab was 92.31% when followed up 6 months after surgery, which was significantly improved compared with 7 days after surgery. CONCLUSION Under multiple small incision channels, UBE can effectively treat multi-level lumbar spinal stenosis, significantly relieve the clinical symptoms of patients, and significantly improve the quality of life of patients. It is a safe and feasible minimally invasive surgical treatment method for multi-level lumbar spinal stenosis.
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Affiliation(s)
- Dingding Jia
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xin Qiao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xuepan Wang
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Shaoqing Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Qiang Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Yunbing Hao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xiangping Peng
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China.
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Wu T, Liu D, Meng F, Lu JH, Chen YF, Fan Z. Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note. Clin Interv Aging 2024; 19:41-50. [PMID: 38204961 PMCID: PMC10778199 DOI: 10.2147/cia.s443792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Tong Wu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Da Liu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Fanhe Meng
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Jing-han Lu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yi-feng Chen
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Zheng Fan
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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He Y, Wang H, Yu Z, Yin J, Jiang Y, Zhou D. Unilateral biportal endoscopic versus uniportal full-endoscopic for lumbar degenerative disease: A meta-analysis. J Orthop Sci 2024; 29:49-58. [PMID: 36437152 DOI: 10.1016/j.jos.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/31/2022] [Accepted: 10/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the increasing use of unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UPFE) techniques in lumbar degenerative disease (LDD), few comprehensive and systematic studies have been published comparing UBE and UPFE. Therefore, we conducted a meta-analysis to compare the surgical outcomes of the two procedures. METHODS We searched all studies that compared operative outcomes of UBE and UPFE for lumbar disc degeneration disease from PubMed, Google Scholar, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang and other databases up to March 30, 2022. RESULTS This meta-analysis, which included nine articles, showed that in operative time, (mean difference [MD]: 17.14; 95% confidence intervals [CI]: 6.52 to 27.76), intraoperative bleeding (MD: 59.01; 95% CI: 21.29 to 96.73) and hospital stay (MD: 2.12; 95% CI: 0.35 to 3.90), the UPFE group was more advantageous. UBE had an advantage in terms of postoperative dural expansion area (MD: 59.01; 95% CI: 21.29 to 96.73). These aspects included postoperative clinical score (MD: 0.48; 95% CI: -0.27 to 1.24; MD: -0.07; 95% CI: -0.30 to 0.16; MD: 0.09; 95% CI: -0.09 to 0.26; MD: 0.11; 95% CI: -0.04 to 0.26; MD: -0.81; 95% CI: -3.03 to 1.41; MD: -0.38; 95% CI: -1.02 to 0.26), excellent and good rate (odds ratio [OR] = 1.08; 95% CI: 0.34 to 3.44), complications (OR = 0.82; 95% CI: 0.31 to 2.12), postoperative hospital stay (MD: 1.63; 95% CI: -0.81 to 4.07) and mean number of fluoroscopies (MD: -7.18; 95% CI: -22.84 to 8.48), with no significant difference between the two groups. Meanwhile, the lumbar disc herniation (LDH) subgroup of UPFE had a significantly shorter operation time (MD: 31.67; 95% CI: 12.44 to 50.90) than that of UBE. CONCLUSION Our study showed that UPFE was associated with shorter operative time, less intraoperative bleeding and shorter hospital stay, whereas UBE was associated with a greater increase in postoperative dural sac area. Postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, satisfaction rates, complications, and mean number of fluoroscopic views were not dramatically dissimilar in UBE and UPFE for LDD. In the LDH subgroup, postoperative hospital stay and operative time were significantly lower in the UPFE group than in the UBE group.
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Affiliation(s)
- Yanxing He
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Hao Wang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Zhentang Yu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China; Dalian Medical University, Liaoning, China.
| | - Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
| | - Yuqing Jiang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
| | - Dong Zhou
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, 213003, China.
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Wang X, Tian Z, Mansuerjiang M, Younusi A, Xu L, Xiang H, Cao L, Wang C. A single-arm retrospective study of the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis. Front Surg 2023; 9:1062451. [PMID: 36756660 PMCID: PMC9901529 DOI: 10.3389/fsurg.2022.1062451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The purpose of this study was to investigate the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) for lumbar spinal stenosis (LSS). Methods Patients who underwent UBE-TLIF due to single-segment LSS between August 2019 and July 2021 were retrospectively included in the study. Clinical outcomes evaluated include operative time, estimated blood loss (including postoperative drainage), time to ambulation, postoperative hospital stay, complications, visual analog scale (VAS) scores of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and modified Macnab criteria. Interbody bony fusion at the index level was assessed using Bridwell grading criteria. Results A total of 73 patients (29 males and 44 females) were enrolled in this study. All surgeries were successfully performed without intraoperative conversion to open surgery. Magnetic resonance imaging (MRI) revealed optimal direct neural decompression after UBE-TLIF. The mean operative time was 150.89 ± 15.58 min. The mean estimated blood loss was 126.03 ± 17.85 ml (postoperative drainage was 34.84 ± 8.31 ml). Time to ambulation was 2.0 ± 0.75 days after the procedure. Postoperatively, the mean hospital stay was 5.96 ± 1.38 days. VAS scores of low back pain and leg pain, JOA, and ODI were significantly improved postoperatively compared with those before the operation, and differences were statistically significant (P < 0.05). Excellent and good outcomes were reported by 87.67% of patients according to the modified Macnab criteria at the final follow-up. A total of nine perioperative complications occurred, with an incidence of 12.33%. X-ray or computerized tomography (CT) 6 months after the procedure showed that 37 cases (50.68%) presented with segmental fusion, 30 cases (41.10%) showed incomplete fusion, and 6 cases (8.22%) showed no signs of fusion. However, bony fusion was achieved in all cases at the final follow-up. Conclusions UBE-TLIF for LSS has the advantages of less surgical invasiveness and fast postoperative recovery.
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Affiliation(s)
| | | | | | | | | | | | - Li Cao
- Correspondence: Chong Wang Li Cao
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Xie Y, Mei X, Liu S, Fiani B, Fan X, Yu Y. Postoperative Intracranial Hemorrhage after an Endoscopic L5-S1 Laminectomy and Discectomy: A Case Report and Literature Review. J Pers Med 2023; 13:196. [PMID: 36836431 PMCID: PMC9958620 DOI: 10.3390/jpm13020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postoperative intracranial hemorrhage (PIH) is a fairly rare but catastrophic perioperative complication following lumbar spine surgery. This is a case report of a 54-year-old male patient who experienced PIH 2 h after an endoscopic L5-S1 laminectomy and discectomy. CASE PRESENTATION A 54-year-old male patient presented with right L5-S1 radiculopathy that corresponded with the picture revealed in medical imaging and the signs seen upon physical examination. Subsequently, he underwent endoscopic L5-S1 laminectomy and discectomy. The patient presented with idiopathic unconsciousness and limb twitching 2 h after surgery. An emergency cranial CT scan was obtained which demonstrated intracranial hemorrhage. Following an emergency consultation with the Department of Neurology and Neurosurgery, the patient underwent an emergency interventional thrombectomy as per their orders. The surgery was performed successfully. However, the patient's situation did not improve and he died on the second postoperative day. CONCLUSION PIH after spinal endoscopic surgery is a rare but horrible complication. Several factors could lead to PIH. However, in this patient, the cause of PIH might be attributed to the long operation time combined with cerebrospinal fluid (CSF) leakage. Great attention should be attached to the issue of PIH development in spinal endoscopic procedures due to constant irrigation. This study aims to highlight the issue of PIH following endoscopic spinal surgery by presenting a case report of a patient who died despite successful surgery.
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Affiliation(s)
- Yizhou Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Xi Mei
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Shanyu Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Brian Fiani
- Department of Neurological Surgery, Weill Cornell Medical College-New York Presbyterian, New York, NY 10065, USA
| | - Xiaohong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
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Hu Y, Fu H, Yang D, Xu W. Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis. Front Surg 2023; 9:1061566. [PMID: 36684266 PMCID: PMC9852342 DOI: 10.3389/fsurg.2022.1061566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS). Methods We retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined. Results The mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm2. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68 ∘ , contralateral was 65.07 ± 4.98 ∘ . The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral). Conclusions UBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.
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Affiliation(s)
- Yutong Hu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Hao Fu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Dongfang Yang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
| | - Weibing Xu
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
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Chun YM, Lee SH, Moon KS, Chang MC. Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch: a case report. J Int Med Res 2022; 50:3000605221144147. [PMID: 36545840 PMCID: PMC9793011 DOI: 10.1177/03000605221144147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We present a case of a dural tear associated with nerve root herniation following unilateral biportal endoscopic decompression (UBED) that was successfully treated using a computed tomography-guided epidural blood patch. A 60-year-old man underwent UBED for radicular pain because of spinal stenosis at L4-5. A left partial hemilaminectomy and flavectomy were performed; however, the left dorsolateral side dura mater was torn during the procedure. TachoComb® was applied at the dural tear site, and the pain was relieved following UBED. However, 3 weeks post-UBED, the patient reported severe pain with an electric shock-like sensation in the left buttock and posterior thigh region with no other neurologic symptoms. The pain was aggravated by standing and spinal motion. Follow-up lumbar spinal magnetic resonance imaging was performed. Axial images indicated protrusion of the left S2 nerve root through the left dorsolateral side of the dura mater. The patient was further diagnosed with nerve root herniation following a dura mater tear. A computed tomography-guided epidural blood patch was performed, with successful therapeutic results. The outcome of this study indicates that a small dural tear that occurs during minimally invasive spinal surgery can be efficiently treated using an epidural blood patch prior to open surgery.
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Affiliation(s)
- Yoon Mok Chun
- Department of Physical Medicine and Rehabilitation, Wooridul
Spine Hospital, Gimpo Airport, Seoul, Republic of Korea
| | - Sang Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul,
Republic of Korea
| | - Kang Suk Moon
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul,
Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of
Medicine, Yeungnam University, Daegu, Republic of Korea,Min Cheol Chang, Department of Physical
Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1,
Daemyungdong, Namku, Taegu 705-717, Republic of Korea.
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Zhang Q, Wei Y, Wen L, Tan C, Li X, Li B. An overview of lumbar anatomy with an emphasis on unilateral biportal endoscopic techniques: A review. Medicine (Baltimore) 2022; 101:e31809. [PMID: 36482646 PMCID: PMC9726330 DOI: 10.1097/md.0000000000031809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Unilateral biportal endoscopy (UBE) is a major surgical technique used to treat degenerative lumbar diseases. The UBE technique has the advantages of flexible operation, high efficiency, and a large observation and operation space. However, as a typical representative of minimally invasive techniques, UBE still needs to complete a wide range of decompression and tissue resection in a narrow working space, resulting in many surgery-associated injuries. Therefore, it is necessary to reduce complications by familiarity with the anatomy of the lumbar spine. Based on the UBE technique, this review article provides historical and current information on the anatomical structures of the lumbar vertebrae, such as the articular process, pedicle, lamina, ligamentum flavum, nerve root, intervertebral disc, and artery supply.
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Affiliation(s)
- Qiang Zhang
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Yongan Wei
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Li Wen
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Chang Tan
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Xinzhi Li
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
- * Correspondence: Xinzhi Li and Bo Li, Department of Orthopedics, China Three Gorges University, Renhe Hospital, No. 410 Yiling Road, Yi Chang 443008, China (e-mails: ; )
| | - Bo Li
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
- * Correspondence: Xinzhi Li and Bo Li, Department of Orthopedics, China Three Gorges University, Renhe Hospital, No. 410 Yiling Road, Yi Chang 443008, China (e-mails: ; )
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Complications of Unilateral Biportal Endoscopic Lumbar Discectomy: A Systematic Review. World Neurosurg 2022; 168:359-368.e2. [DOI: 10.1016/j.wneu.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
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张 玉, 田 霖, 胡 鹏, 芦 怀. [Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1234-1240. [PMID: 36310460 PMCID: PMC9626282 DOI: 10.7507/1002-1892.202205087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/14/2022] [Indexed: 01/24/2023]
Abstract
Objective To review the application and research progress of unilateral biportal endoscopy (UBE) technique in the treatment of lumbar related diseases. Methods The domestic and foreign literature on the application of UBE technique in the treatment of lumbar related diseases was extensively consulted, and the development history, clinical application, operation points and precautions, related complications and adverse reactions, advantages and disadvantages of the technique were reviewed. Results As a minimally invasive technique developed in recent years, UBE technique is effective in the treatment of lumbar spinal stenosis caused by different causes, with satisfactory decompression effect, less damage, and good lumbar stability. UBE technique has significant advantages over open surgery and microscopy-assisted surgery in the treatment of lumbar disc herniation. In the treatment of lumbar spondylolisthesis, the postoperative trauma of UBE technique is less than that of conventional surgery, and the fusion rate is satisfactory. There are also complications such as spinal cord injury, spinal epidural hematoma, incomplete decompression or recurrence, nerve root irritation symptoms, and postoperative infection in the treatment of lumbar related diseases with UBE technique. Detailed preoperative planning is essential for patients with lumbar related diseases who are suitable for UBE surgery. Conclusion UBE technique is easy to operate, has a gentle learning curve, can use conventional instruments, and has definite effectiveness. It is suitable for a variety of lumbar related diseases, but there are some defects and deficiencies.
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Affiliation(s)
- 玉红 张
- 滨州医学院附属医院脊柱外科(山东滨州 256603)Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 霖 田
- 滨州医学院附属医院脊柱外科(山东滨州 256603)Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 鹏 胡
- 滨州医学院附属医院脊柱外科(山东滨州 256603)Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 怀旺 芦
- 滨州医学院附属医院脊柱外科(山东滨州 256603)Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
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王 建, 刘 鑫, 任 佳, 刘 彬, 李 岳, 刘 昌, 耿 晓, 窦 永, 孙 兆. [Imaging study and clinical application of unilateral biportal endoscopy technique for upper lumbar disc herniation via contralateral approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1213-1220. [PMID: 36310457 PMCID: PMC9626279 DOI: 10.7507/1002-1892.202205017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the relationships between the bony structures, nerve, and indentations of ligamentum flavum of the upper lumbar spine by using CT three-dimensional reconstruction technique, in order to guide the unilateral biportal endoscopy (UBE) technique via contralateral approach in the treatment of upper lumbar disc herniation (ULDH). Methods Twenty-one ULDH patients who were admitted between June 2019 and July 2021 and met the selection criteria were selected as the research subjects. There were 12 males and 9 females with an average age of 62.1 years (range, 55-72 years). The disease duration was 1-12 years (mean, 5.7 years). There was 1 case of L 1, 2, 4 cases of L 2, 3, and 16 cases of L 3, 4. The CT myelography data of T 12-S 3 segment was saved in DICOM format and imported into Mimics21.0 software for three-dimensional reconstruction. The relationship between the intersection (point Q) of spinous process and the inferior margin of lamina, the indentation of superior margin of ligamentum flavum, the inferior margin of nerve root origin, intervertebral space, and foramen were observed. The Mimics21.0 software was used to create a 3-mm-diameter cylinder to simulate the UBE channel and measure its abduction angle (∠b1), as well as measure the following lumbar vertebra-related indicators: in L 1,2-L 3,4 segments, the vertical distance from the point Q to the inferior margin of the contralateral lumbar pedicle of the same lumbar vertebra (a1), the superior margin of the contralateral pedicle of the lower lumbar vertebra (a2), the lower endplate of the same lumbar vertebra (a3), the upper endplate of the lower lumbar vertebra (a4); the vertical distance from the lower endplate of lumbar vertebra to the inferior margin of the lumbar pedicle (c1), the vertical distance from the upper endplate of the lower lumbar vertebra to the superior margin of the lumbar pedicle (c2); the vertical distance from the inferior margin of the nerve root origin to the superior margin (d1) and the inferior margin (d2) of the lumbar pedicle, respectively; the vertical distance from the intersection (point P) of the indentation of superior margin of ligamentum flavum and the medial margin of the lumbar pedicle to the superior margin (e1) and the inferior margin (e2) of the lumbar pedicle, respectively; the horizontal distance from the lateral margin of the dural mater (f1) and the narrowest part of the lumbar isthmus (f2) to the facet joint space, respectively. Thirteen of the patients included in the study chose the UBE surgery via contralateral approach. There were 8 males and 5 females with an average age of 63.3 years (range, 55-71 years). The disease duration was 2-12 years, with an average of 6.2 years. There were 3 cases of L 2, 3 and 10 cases of L 3, 4. The perioperative complications and surgical decompression were recorded. And the effectiveness were evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and short form-36 health survey (SF-36) score. Results The imaging results showed that there was no significant difference in a1, a3, a4, e1, e2, f1, and f2 between segments ( P>0.05), and there were significant differences ( P<0.05) in a2 and c2 between L 1, 2 and L 3, 4 segments, in ∠b1 and d2 between L 1, 2, L 2, 3 segments and L 3, 4 segments, and in c1 and d1 between L 1, 2 and L 2, 3, L 3, 4 segments. The 87.30% (110/126) of point Q of L 1, 2-L 3, 4 segments corresponded to the inferior articular process, and 78.57% (99/126) of the lower endplate corresponded to the level of the isthmus. All 13 patients completed the UBE surgery via contralateral approach, and none were converted to open surgery. All patients were followed up 12-17 months (mean, 14.6) months. The VAS score of low back pain and leg pain, ODI, and SF-36 score at 6 and 12 months after operation significantly improved when compared with those before operation ( P<0.05), and further improved at 12 months after operation when compared with 6 months after operation ( P<0.05). The imaging review results showed that the herniated disc was removed and the dura mater was decompressed adequately. Conclusion The point Q, the superior margin of ligamentum flavum, and lumbar pedicle can be used as the markers for the treatment of ULBD with UBE surgery via contralateral approach, making the procedure safer, more precise, and more effective.
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Affiliation(s)
- 建业 王
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 鑫 刘
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 佳彬 任
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 彬 刘
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 岳飞 李
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 昌震 刘
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 晓鹏 耿
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 永峰 窦
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
| | - 兆忠 孙
- 滨州医学院附属医院脊柱外科(山东滨州 256600)Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256600, P. R. China
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Krystkiewicz K, Maślanka M, Skadorwa T, Ciszek B, Tosik M, Furtak J. Meningovertebral ligaments could be a barrier for migration of a herniated intervertebral disc: An anatomical study. Front Surg 2022; 9:969244. [PMID: 36157428 PMCID: PMC9489937 DOI: 10.3389/fsurg.2022.969244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Intervertebral disc degeneration can manifest as sequestration. In most cases, the material could be found ipsilateral to the annular tear; however, a contralateral migration is also possible. We present an anatomical description of anterior meningovertebral ligaments (MVLs) as a possible barrier for disc migration. Methods Anatomical dissection of 20 fresh human cadavers was carried out. Complete lumbar laminectomies with facetectomies were performed. All lumbar segments were exposed. Morphologic and morphometric descriptions of anterior MVLs were presented, with special attention to possible routes of herniated disc migration. Results Anterior MVLs were present in all cases. They were divided in three separate groups: medial, lateral, and attached to the nerve roots. The medial group was the thickest, its mean length was 26.2 ± 1.2 mm, and it had no attachment to the disc in 51% of cases. The lateral group was less firm than the medial group, its mean length was 26.9 ± 1.0 mm, and it had no relation with the disc in 47% of cases. Ligaments related to the nerve root were the most delicate and always attached to the intervertebral disc. Their mean length was 14.9 ± 1.8 mm. Conclusions The medial group of anterior MVLs are strong connective tissue bands dividing the anterior epidural space. The lateral group is more delicate, and in most cases, lateral MVLs lack annular attachment. MVLs could be an anatomical barrier for disc migration in particular cases.
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Affiliation(s)
- Kamil Krystkiewicz
- Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Łódź, Poland
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Kamil Krystkiewicz
| | - Mateusz Maślanka
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, Warsaw, Poland
| | - Tymon Skadorwa
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, Warsaw, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, Warsaw, Poland
| | - Marcin Tosik
- Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Łódź, Poland
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
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Chen L, Zhu B, Zhong HZ, Wang YG, Sun YS, Wang QF, Liu JJ, Tian DS, Jing JH. The Learning Curve of Unilateral Biportal Endoscopic (UBE) Spinal Surgery by CUSUM Analysis. Front Surg 2022; 9:873691. [PMID: 35574554 PMCID: PMC9099005 DOI: 10.3389/fsurg.2022.873691] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/30/2022] [Indexed: 01/24/2023] Open
Abstract
ObjectiveTo assess the learning curve of the unilateral biportal endoscopic (UBE) technique for the treatment of single-level lumbar disc herniation by cumulative summation (CUSUM) method analysis.MethodsA retrospective analysis was conducted to assess 97 patients' general condition, operation time, complications, and curative effect of single segmental UBE surgery performed by a spinal surgeon in his early stage of this technique. The learning curve of operation time was studied using a CUSUM method, and the cut-off point of the learning curve was obtained.ResultsThe operation time was 30 – 241(97.9 ± 34.7) min. The visual analog scale score of lower limb pain decreased from 5.75 ± 0.81 before the operation to 0.39 ± 0.28 at the last follow-up (P < 0.05). The Oswestry disability index score decreased from 66.48 ± 4.43 before the operation to 14.57 ± 3.99 at the last follow-up (P < 0.05). The CUSUM assessment of operation time revealed the learning curve was the highest in 24 cases. In the learning stage (1–24 cases), the operation time was 120.3 ± 43.8 min. In the skilled stage (25–97 cases), the operation time was 90.5 ± 27.8 min.ConclusionsAbout 24 cases of single segmental UBE operation are needed to master the UBE technique.
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Chu PL, Wang T, Zheng JL, Xu CQ, Yan YJ, Ma QS, Meng-Chen Y, Da-Sheng T. Global and Current Research Trends of Unilateral Biportal Endoscopy/Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Degenerative Diseases: A Bibliometric and Visualization Study. Orthop Surg 2022; 14:635-643. [PMID: 35293686 PMCID: PMC9002063 DOI: 10.1111/os.13216] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 01/19/2023] Open
Abstract
The study aimed to make a bibliometric analysis of the current research situation in unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS). Research data sets were acquired from the Web of Science database. The study chosed “biportal endoscopic spinal surgery” OR “two portal endoscopic spinal surgery” OR “percutaneous biportal endoscopic decompression” OR “unilateral biportal endoscopy” OR “irrigation endoscopic discectomy” as the search terms. The literature search was limited to articles published before March 5, 2021. We only included original articles and reviews. VOS viewer and Citespace software were used to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H‐index status, co‐authorship status, and research hotspots were analyzed. A total of 74 publications met the requirement. The sum number of citations was 31,204, in which 19,336 were no self‐citations. The average citation of all the papers was 21.84 times. The H‐index of all the publications was 85. South Korea's total number of articles was far higher than that of other countries and regions (61, 82.4%), followed by United Arab Emirates, Egypt, and Peoples Republic of China (three, ranking second, accounting for 12.2% of the total). For the most productive authors, Choi ranked first with 21 articles, Kim ranked second with 16 articles, and Heo ranked third with 12 articles. The journal with the greatest number of publications was World Neurosurgery, with a total of 18 (39.1%) papers. Clinics in Orthopedic Surgery ranked second with six (13.0%) papers. In third place, there were fix articles published by Asian Spine Journal and Neurospine, accounting for 21.8% of the total articles. These top three journals accounted for 73.9% of all the papers. Spondylolisthesis and endoscopic decompression were the research hotspots in recent years. The number of publications has showed an upward trend with a stable rise in recent years. South Korea is the country with the highest productivity, not only in quality, but also in quantity. Barun Hosp and Leon Wiltse Mem Hosphave published most articles. Choi is the most productive author. World Neurosurgery is the most productive journal. Spondylolisthesis and endoscopic decompression are the research hotspots in recent years. Indeed, this study provides new insight into the growth and development of UBE/BESS.
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Affiliation(s)
- Pei-Lin Chu
- Department of Orthopaedics, Maanshan General Hospital of Ranger-Duree Healthcare, Anhui, China
| | - Tao Wang
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Anhui, China
| | - Jia-le Zheng
- Department of Orthopaedics, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chong-Qing Xu
- Department of Orthopaedics, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin-Jie Yan
- Department of Orthopaedics, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing-Shan Ma
- Department of Orthopaedics, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin Meng-Chen
- Department of Orthopaedics, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tian Da-Sheng
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Anhui, China
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Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res 2022; 17:30. [PMID: 35033143 PMCID: PMC8760683 DOI: 10.1186/s13018-022-02929-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.
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Affiliation(s)
- Hao-Wei Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Cheng-Dong Chen
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Bi-Shui Zhan
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Yong-Li Wang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Pan Tang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Xue-Sheng Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
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Zou F, Zhang L, Zou X, Huang J, Nie C, Jiang J, Guo C, Wang H, Ma X, Ji M. Differential characterization of lumbar spine associated tissue histology with nonlinear optical microscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:474-484. [PMID: 35154886 PMCID: PMC8803016 DOI: 10.1364/boe.446351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Percutaneous endoscopic lumbar discectomy (PELD) is the major effective treatment for lumbar disc herniation, and rapid histological identification of dissected tissue is critical to guide the discectomy. In this work, we revealed the histological features of different types of peridural tissues of the lumbar spine by label-free multi-modal nonlinear optical microscopy. Stimulated Raman scattering (SRS) was used to extract lipid and protein distributions, while second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) signals were applied to image the collagen and elastin fibers at the same time. Our results demonstrated that the nonlinear optical features of the dura and adjacent soft tissues were significantly different, showing the potentials of our method for intraoperative differentiation of these critical tissues and improving the surgical outcome of PELD.
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Affiliation(s)
- Fei Zou
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
- These authors contributed equally
| | - Lili Zhang
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
- State Key Laboratory of Infrared Physics, Shanghai Institute of Technical Physics, Chinese Academy of Sciences, Shanghai 200083, China
- These authors contributed equally
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
- These authors contributed equally
| | - Jing Huang
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
| | - Cong Nie
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chongyuan Guo
- Shanghai Starriver Bilingual School, Shanghai 201108, China
| | - Hongli Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Minbiao Ji
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
- Yiwu Research Institute of Fudan University, Chengbei Road, Yiwu City, Zhejiang 322000, China
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Efficacy and Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review. World Neurosurg 2021; 159:e91-e102. [PMID: 34890849 DOI: 10.1016/j.wneu.2021.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE As an emerging minimally invasive endoscopic technique, unilateral biportal endoscopic spinal surgery (UBESS) has the advantages of flexibility, a wide and clear field of view, and less soft tissue damage. However, the clinical evidence is insufficient and controversy exists regarding UBESS for the treatment of lumbar spinal stenosis (LSS). In the present meta-analysis, we investigated the clinical efficacy and complications of UBESS for the treatment of LSS. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were searched through to June 1, 2021 to identify all reported studies on UBESS for LSS. Only English-language studies with original reported data from ≥30 cases were considered for inclusion. The patient demographics, operative time, hospital stay, complications, visual analog scale (VAS) score, Oswestry disability index, and Macnab criteria were extracted. Quality assessment was performed using the Cochrane collaboration tool for randomized controlled trials and the Newcastle-Ottawa scale for retrospective studies. A meta-analysis was performed using a random or fixed effect model according to the heterogeneity. RESULTS Thirteen studies with 586 patients and 607 operation levels were included. The mean single-level operative time, hospital stay, and follow-up duration were 61.10 minutes, 2.32 days, and 14.7 months, respectively. At the final follow-up visit, the mean VAS score for leg pain had decreased from 7.23 preoperatively to 1.83 postoperatively, the mean VAS score for back pain had decreased from 6.30 to 1.95, and the mean Oswestry disability index had significantly improved from 56.99 to 17.83. The average satisfied outcome (excellent or good using the Macnab criteria) was 86%. The overall complication rate was 5%, and the most common complication was a dural tear, with an incidence of 2%, followed by epidural hematoma with an incidence of 1%. The remaining complications were nerve root injury, inadequate decompression, and postoperative headache. CONCLUSIONS From the available clinical results and experience from reported studies, UBESS for LSS is a feasible and effective approach and a worthwhile choice for clinicians. However, the complications associated with the procedure should also be seriously considered.
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