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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Endoscopy | Research article

One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study

Authors: Tusheng Li, Qiang Jiang, Wei Zhong, Tengyue Zhu, Zhengcao Lu, Yu Ding

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

The one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS).

Methods

One hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST).

Results

After PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) (P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant (P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups (P > 0.05). However, all clinical and functional scores significantly improved postoperatively (P < 0.05). Postoperative DCSA of both groups was significantly found to be improved (P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference (P = 0.713).

Conclusion

OSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.

Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. https://doi.org/10.1136/bmj.h6234.CrossRefPubMedPubMedCentral

Xu J, Wang D, Liu J, et al. Learning curve and complications of unilateral biportal endoscopy: cumulative sum and risk-adjusted cumulative sum analysis. Neurospine. 2022;19:792–804. https://doi.org/10.14245/ns.2143116.558.CrossRefPubMedPubMedCentral

Ko S, Oh T. Comparison of bilateral decompression via unilateral laminotomy and conventional laminectomy for single-level degenerative lumbar spinal stenosis regarding low back pain, functional outcome, and quality of life: a randomized controlled, prospective trial. J Orthop Surg Res. 2019. https://doi.org/10.1186/s13018-019-1298-3.CrossRefPubMedPubMedCentral

Bui AT, Trinh GM, Wu M, Hoang TT, Hu M, Pao J. Indications for and outcomes of three unilateral biportal endoscopic approaches for the decompression of degenerative lumbar spinal stenosis: a systematic review. Diagnostics. 2023;13:1092. https://doi.org/10.3390/diagnostics13061092.CrossRefPubMedPubMedCentral

Hermansen E, Austevoll IM, Hellum C, et al. Comparison of 3 different minimally invasive surgical techniques for lumbar spinal stenosis. JAMA Netw Open. 2022;5:e224291. https://doi.org/10.1001/jamanetworkopen.2022.4291.CrossRefPubMedPubMedCentral

Chang F, Zhang T, Gao G, et al. Comparison of the minimally invasive and conventional open surgery approach in the treatment of lumbar stenosis: a systematic review and a meta-analysis. Ann Acad Med Singap. 2017;46:124–37.CrossRefPubMed

Choi D, Kim J. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg. 2019;11:82. https://doi.org/10.4055/cios.2019.11.1.82.CrossRefPubMedPubMedCentral

Zheng B, Xu S, Guo C, Jin L, Liu C, Liu H. Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: a systematic review and meta-analysis. Front Surg. 2022. https://doi.org/10.3389/fsurg.2022.911914.CrossRefPubMedPubMedCentral

Zhang Y, Feng B, Hu P, Dai G, Su W. One-hole split endoscopy technique versus unilateral biportal endoscopy technique for l5–s1 lumbar disk herniation: analysis of clinical and radiologic outcomes. J Orthop Surg Res. 2023;18:668. https://doi.org/10.1186/s13018-023-04159-9.CrossRefPubMedPubMedCentral

10.

Liu C, Zhang W, Wang C, et al. Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a 1-year retrospective cohort study. J Orthop Surg Res. 2024;19:123. https://doi.org/10.1186/s13018-024-04574-6.CrossRefPubMedPubMedCentral

11.

Frymoyer JW, Selby DK. Segmental instability. Rationale for treatment. Spine (Phila Pa 1976). 1985;10:280–6. https://doi.org/10.1097/00007632-198504000-00017.CrossRefPubMed

12.

Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976). 1990;15:571–6. https://doi.org/10.1097/00007632-199006000-00026.CrossRefPubMed

13.

Wang M, Su Z, Liu Z, et al. Deep learning-based automated magnetic resonance image segmentation of the lumbar structure and its adjacent structures at the l4/5 level. Bioengineering. 2023;10:963. https://doi.org/10.3390/bioengineering10080963.CrossRefPubMedPubMedCentral

14.

Hu H, Wang X, Yang H, Zhang J, Li K, Zeng J. development and validation of an automatic diagnostic tool for lumbar stability based on deep learning. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023;37:81–90. https://doi.org/10.7507/1002-1892.202209058.CrossRefPubMed

15.

Trinh GM, Shao H, Hsieh KL, et al. Detection of lumbar spondylolisthesis from x-ray images using deep learning network. J Clin Med. 2022;11:5450. https://doi.org/10.3390/jcm11185450.CrossRefPubMedPubMedCentral

16.

Claus CF, Lawless M, Lytle E, et al. The effect of morbid obesity on complications, readmission, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion: an inverse propensity score weighted analysis. Spine (Phila Pa 1976). 2021;46:1394–401. https://doi.org/10.1097/BRS.0000000000004059.CrossRefPubMed

17.

Andrade C. Mean difference, standardized mean difference (smd), and their use in meta-analysis. J Clin Psychiatr. 2020. https://doi.org/10.4088/JCP.20f13681.CrossRef

18.

Yeager MS, Cook DJ, Cheng BC. Reliability of computer-assisted lumbar intervertebral measurements using a novel vertebral motion analysis system. Spine J. 2014;14:274–81. https://doi.org/10.1016/j.spinee.2013.10.048.CrossRefPubMed

19.

Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and management of lumbar spinal stenosis. JAMA. 2022;327:1688. https://doi.org/10.1001/jama.2022.5921.CrossRefPubMed

20.

Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine (Phila Pa 1976). 2000;25:1424–35. https://doi.org/10.1097/00007632-200006010-00016.CrossRefPubMed

21.

Pao J, Lin S, Chen W, Chang C. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. J Spine Surg. 2020;6:438–46. https://doi.org/10.21037/jss.2020.03.08.CrossRefPubMedPubMedCentral

22.

Burkhard MD, Calek A, Fasser M, et al. Biomechanics after spinal decompression and posterior instrumentation. Eur Spine J. 2023;32:1876–86. https://doi.org/10.1007/s00586-023-07694-5.CrossRefPubMed

23.

De Antoni DJ, Claro ML, Poehling GG, Hughes SS. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy. 1996;12:330–4. https://doi.org/10.1016/s0749-8063(96)90069-9.CrossRefPubMed

24.

Choi CM, Chung JT, Lee SJ, Choi DJ. How i do it? Biportal endoscopic spinal surgery (bess) for treatment of lumbar spinal stenosis. Acta Neurochir. 2016;158:459–63. https://doi.org/10.1007/s00701-015-2670-7.CrossRefPubMed

25.

Tan B, Yang Q, Fan B, Xiong C. Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: a comparative study with decompression via open discectomy. Front Neurol. 2023. https://doi.org/10.3389/fneur.2023.1132698.CrossRefPubMedPubMedCentral

26.

Jiang H, Chen C, Zhan B, Wang Y, Tang P, Jiang X. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res. 2022. https://doi.org/10.1186/s13018-022-02929-5.CrossRefPubMedPubMedCentral

27.

Zhu W, Yao Y, Hao J, Li W, Zhang F. Short-term postoperative pain and function of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for single-segment lumbar disc herniation: a systematic review and meta-analysis. Appl Bionics Biomech. 2022;2022:1–8. https://doi.org/10.1155/2022/5360277.CrossRef

28.

Hwa Eum J, Hwa Heo D, Son SK, Park CK. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine. 2016;24:602–7. https://doi.org/10.3171/2015.7.SPINE15304.CrossRefPubMed

29.

Yuan C, Wen B, Lin H. Clinical analysis of minimally invasive percutaneous treatment of severe lumbar disc herniation with ube two-channel endoscopy and foraminal single-channel endoscopy technique. Oxid Med Cell Longev. 2022;2022:1–9. https://doi.org/10.1155/2022/9264852.CrossRef

30.

Misal U, Joshi S, Shaikh M. Delayed recovery from anesthesia: a postgraduate educational review. Anesth: Essays Res. 2016;10:164. https://doi.org/10.4103/0259-1162.165506.CrossRefPubMed

31.

Bekelis K, Coy S, Simmons N. Operative duration and risk of surgical site infection in neurosurgery. World Neurosurg. 2016;94:551–5. https://doi.org/10.1016/j.wneu.2016.07.077.CrossRefPubMed

32.

Zdeblick TA, Zou D, Warden KE, Mccabe R, Kunz D, Vanderby R. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Jt Surg Am. 1992;74:22–7.CrossRef

33.

Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63:278–82. https://doi.org/10.3171/jns.1985.63.2.0278.CrossRefPubMed

34.

Zhang Y, Feng B, Ning H, et al. One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique. J Orthop Surg Res. 2023;18:483. https://doi.org/10.1186/s13018-023-03967-3.CrossRefPubMedPubMedCentral

Title: One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study
Authors: Tusheng Li
Qiang Jiang
Wei Zhong
Tengyue Zhu
Zhengcao Lu
Yu Ding
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Endoscopy
Spinal Stenosis
Incision
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04743-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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