Clinical observation of unilateral biportal endoscopy surgery for highly free type lumbar disc herniation
Zhu Xiaojian1, Cao Jianhua1, Li Yuqian2, Wang Zhen2, Ding Zhengmei1, Qin Xiaodong1, Liu Ertao1, Guo Zhangjian1
1Department of Orthopedics, the Fourth People's Hospital of Nantong, Nantong 226001, China; 2Department of Orthopedics, the Third People's Hospital of Nantong, Nantong 226001, China
Abstract：Objective This study aimed to discuss the clinical efficacy of unilateral biportal endoscopy in the treatment of highly free-type lumbar disc herniation. Methods A retrospective cohort study was conducted. A total of 64 patients with L4/5 and L5/S1 highly free-type lumbar disc herniation were selected from January 2017 to January 2022, including 31 males and 33 females, aged 29-77 (55.6±16.5) years, who were treated by spinal endoscopy at the Orthopedics Department of Nantong the Fourth and the Third People's Hospital. The involved segments included L4/5 and L5/S1 with 36 and 28 patients, respectively. All 64 patients received endoscopic-assisted removal of herniated nucleus pulposus. Among them, 32 patients who used PELD were included in the PELD group, and 32 patients who used UBE were included in the UBE group. The operation time, times of intraoperative fluoroscopy, intraoperative bleeding, hospital stay, and postoperative residual nucleus pulposus, as well as visual analog scale (VAS) score and Oswestry disability index (ODI) of patients with low back and leg pain before the operation, 1 day after the operation and 6 months after the operation were compared between the two groups. The modified Macnab method was used to evaluate the efficacy 6 months after the operation. Results No significant difference was found in baseline data between the two groups (all P values>0.05). In the UBE group, the operation time, intraoperative bleeding, and hospital stay were (70.7±8.8) min, (11.5±2.9) mL, and (4.9±1.2) days, respectively. Meanwhile, in the PETD group, the operation time, intraoperative bleeding, and hospital stay were (66.3±11.9) min, (13.0±3.5) ml, and (5.0±1.3) days, respectively. No significant difference was observed (t=1.72, -1.88, -0.32, all P values>0.05). The number of times of intraoperative fluoroscopy in the UBE group 8.6±2.2 was less than that in the PETD group 15.9±4.2, with a statistically significant difference (t=-8.73, P<0.001). No residual nucleus pulposus was observed in the UBE group. In the PETD group, there were two patients with symptomatic residual nucleus pulposus after the operation, and the residual nucleus pulposus was removed again by PETD. No significant differences were found in VAS scores of low back and leg pain and ODI scores between the two groups before surgery, 1 day, and 6 months after the operation (all P values>0.05). Intra-group comparison: VAS scores of low back and leg pain and ODI of patients in the UBE and PETD groups were significantly improved 1 day and 6 months after the operation when compared with those before the surgery, and the differences were statistically significant (all P values<0.001). The excellent and good rate was 93.8% (30/32) and 90.6% (29/32) in UBE and PETD groups 6 months after the operation, and no significant difference was observed between the two groups (χ2 =0.22, P=0.641). Conclusion UBE and PETD are safe and effective for patients with highly free-type lumbar disc herniation. UBE can remove the nucleus pulposus under direct vision. In addition, it can reduce the probability of residual nucleus pulposus and reduce the number of fluoroscopies as compared with PETD.
朱小建, 曹建华, 李玉前, 王震, 丁正美, 秦晓东, 刘二涛, 郭张建. 单侧双通道内镜手术治疗高度游离型腰椎间盘突出症的临床疗效[J]. 中华解剖与临床杂志, 2023, 28(5): 313-319.
Zhu Xiaojian, Cao Jianhua, Li Yuqian, Wang Zhen, Ding Zhengmei, Qin Xiaodong, Liu Ertao, Guo Zhangjian. Clinical observation of unilateral biportal endoscopy surgery for highly free type lumbar disc herniation. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 313-319.
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2023, Vol. 28 
