Clinical Study Of TE-ULBD In The Treatment Of Ligamentum Flavum Ossifying Thoracic Spinal Stenosis

ObjectiveTo compare the clinical effects of thoracic endoscopic unilateral laminotomy bilateral decompression(TE-ULBD)and " cap uncovering" posterior wall resection and decompression of the spinal canal in the treatment of single-segment ligamentum flavum ossification TSS,To explore the surgical characteristics,safety,clinical efficacy and precautions of TE-ULBD.MethodThe clinical data of 62 patients with single-segment ligamentum flavum ossification TSS admitted to our hospital from September 2017 to July 2021 who met the inclusion and exclusion criteria were retrospectively analyzed.Among them,41 were male and 21 were female.There were 29 cases treated with TE-ULBD surgery(TE-ULBD group),18 males and 11 females;aged 38-70 years old,with the average of 55.24±8.94 years old;the posterior wall resection and decompression of " cap uncovering " spinal canal were used There were 33 cases(23 males and 10 females)treated by surgery(the cap uncovering group).The operation time,blood loss,hospital stay,complications,etc.were compared between the two groups.Before operation,3 days after operation and the last follow-up,Visual Analogue Score(VAS)was used to evaluate the improvement of pain symptoms,and Oswestry Disability Index(ODI)was used to evaluate the postoperative functional recovery of patients.The Japanese orthopaedic association(JOA)scoring method(out of 11 points)was used to evaluate the patients,and to calculate the improvement rate.The area of dural sac before and after operation was measured to evaluate the effect of spinal canal decompression.Statistical analysis was performed to compare the clinical effects of the two surgeries.ResultAll operations were successfully completed,of which 5 cases in the TE-ULBD group and 8 cases in the cap uncovering group had intraoperative dural rupture,all of which were ruptured during the removal of the ligamentum flavum.The TE-ULBD group was covered with gelatin sponge,full-thickness sutured and the incision was bandaged,and the dura mater was repaired and a drainage tube was placed in the cap uncovering group.The patients recovered well after surgery and did not develop related symptoms.No other related complications occurred in all patients.The operation time,hospital time and blood loss in the TE-ULBD group were less than those in the cap uncovering group,and there were significant differences in the operation time,intraoperative blood loss and hospital time between the two groups(P<0.05).Compared with the cover group,there was no significant difference in the VAS score,ODI score and JOA score between the two groups before and at the last follow-up(P>0.05).There was no difference in the cross-sectional area of the dural sac between the two groups before and after surgery Statistical significance(P>0.05),and the evaluation indicators of the two groups of patients in each time period after surgery were significantly different from those before surgery.This fully demonstrates that TE-ULBD has the same surgical effect as the " cap uncovering "method in terms of pain relief and nerve function recovery for the treatment of TSS.However,the VAS score and ODI score of the TE-ULBD group at 3 days after operation were lower than those of the cap uncovering group,and the JOA score was higher than that of the cap uncovering group.There were significant differences in VAS score,ODI score and JOA score 3 days after operation(P<0.05).Studies have shown that TE-ULBD in the treatment of TSS has many unique advantages,such as minimally invasive,safe,fast recovery,and good curative effect.ConclusionTE-ULBD is a safe and effective surgical method for the treatment of single-segment ligamentum flavum ossification-type thoracic spinal stenosis.Compared with the uncovering method,TE-ULBD has the advantages of less trauma,obvious postoperative curative effect,and shorter recovery time.