Analysis Of Clinical Efficacy Of Lumbar Endoscopic Unilateral Laminectomy And Bilateral Decompression In The Treatment Of Degenerative Lumbar Spinal Stenosis

ObjectiveBy comparing the clinical efficacy of lumbar endoscopic unilateral laminotomy bilateral decompression(LE-ULBD)and bilateral laminectomy decompression(BLD)in the treatment of degenerative lumbar spinal stenosis(DLSS),to discuss the surgical operation and related precautions,as well as the advantages and practical value of the lumbar endoscopic unilateral laminotomy bilateral decompression.It is expected to provide certain theoretical support for clinical treatment of DLSS by LE-ULBD.MethodA retrospective analysis of the clinical data of 70 patients with single-segment degenerative lumbar spinal stenosis admitted to our medical group from August 2017 to August 2020.There were 28 males and 42 females;the age was 48～72 years,with an average of 58.74 years;the distribution of responsible segments:L1～L2 5 cases,L2～L3 5 cases,L3～L4 14 cases,L4～L5 42 cases,L5～S1 4 cases.According to the different surgical methods,they are divided into the lumbar endoscopic unilateral laminectomy and bilateral decompression group(LE-ULBD group)and the bilateral laminectomy decompression group(BLD group).Among them,there were 32 cases in the LE-ULBD group,including 12 males and 20 females;aged from 48 to 71 years,with an average age of 59.31 years;the distribution of responsible segment:L1～L2 1 cases,L2～L3 3 cases,L3～L4 6 cases,L4～L5 20 cases,L5～S1 2 cases.There were 38 cases in the BLD group,including 16 males and 22 females;aged 49～72 years old,with an average age of 58.26 years;the distribution of responsible segment:L1～L2 4 cases,L2～L3 2 cases,L3～L4 8 cases,L4～L5 22 cases,L5～S1 2 cases.The operation time,intraoperative blood loss,hospitalization time,intraoperative and postoperative complications were compared between the two groups;The improvement of lower back and leg pain was evaluated according to the Visual Analogue Score(VAS)before operation,3 days after operation,and 6 months after operation.The postoperative functional recovery of patients was evaluated according to the Oswestry Disability Index(ODI)before operation,3 days after operation,and 6 months after operation.The modified MacNab efficacy evaluation standard was used at the last follow-up to evaluate the Curative effect.The Picture Achiving and Communicating System(PACS)is used to measure the cross-sectional area of the dural sac on the T2 phase of the MRI before and after the operation to evaluate the decompression effect.Through statistical analysis of the above indicators,to evaluate the clinical effects of the two surgical treatments for DLSS.ResultThe operations of all patients were successfully completed.There were 2 cases in the LE-ULBD group and 1 case in the BLD group suffered a rupture of the dura mater during the operation.After corresponding treatments such as gelatin sponge packing,placement of drainage,tight suture,and compression bandage,all patients recovered well without any obvious discomfort.All patients had no complications such as nerve root injury,epidural hematoma,infection,postoperative lumbar instability or spondylolisthesis.The operation time,intraoperative blood loss and hospitalization time of the LE-ULBD group were less than those of the PLIF group,and the difference was statistically significant(P<0.05),which shows that compared with BLD,LE-ULBD has the advantages of less trauma and faster postoperative recovery.There was no significant difference in lumber and leg VAS scores between the two groups before surgery,6 months after surgery,and leg pain VAS scores 3 days after surgery.However,the LE-ULBD group had lower lumber VAS scores 3 days after surgery than the BLD group.The difference was statistically significant(P<0.05),suggesting that LE-ULBD can maximize the protection of soft tissues and body structures such as the dorsal muscles and ligaments of the spine,so it can reduce the pain in the surgical area of patients after surgery.There was no significant difference in the ODI scores of the two groups before operation,3 days after operation and 6 months after operation and the modified MacNab efficacy evaluation at the last follow-up(P>0.05);Compared with the preoperative VAS scores and ODI 3 days after operation and 6 months after operation in each group respectively,the difference was statistically significant(P<0.05),indicating that the two surgical methods are effective in relieving pain and improving function,but there is no obvious difference in the both treatment effect.The cross-sectional area of the dural sac before and after the operation was not statistically significant between the two groups(P>0.05);the cross-sectional area of the dural sac after the operation in the two groups was significantly bigger than that before the operation.(P<0.05),suggesting that both surgical procedures can achieve the goal of complete decompression,and there is no significant difference in the decompression effect.ConclusionLE-ULBD and BLD are both safe and effective surgical methods for the treatment of single-segment degenerative lumbar spinal stenosis.Both can achieve satisfactory clinical results in alleviating the symptoms of lumbar and leg pain,improving function and quality of life in patients with DLSS;and Compared with BLD,LE-ULBD has the advantages of shorter operation time,less trauma,less bleeding,faster postoperative functional recovery,and shorter hospital stay.It can protect the stability of the spine to the greatest extent,but its operation is more difficult and the learning curve is steep.Before clinical development,you need to be proficient in spine endoscopy related technologies.