Comparison Of The Efficacy Of Unilateral Biportal Endoscopic Lumbar Interbody Fusion And Percutaneous Coaxial Large-Channel Endoscopic Lumbar Interbody Fusion In Treating Lumbar Degenerative Diseases

Background Lumbar degenerative diseases(LDD)is a kind of age-related diseases,and with the extension of the life span of the population,its incidence increases year by year.It has become one of the common diseases of the middle-aged and elderly population,which seriously affects the quality of life of patients and increases the economic burden.Lumbar fusion is an effective method for the treatment of LDD.Currently,minimally invasive fusion technology is developing rapidly,bringing more benefits to patients with LDD.Objective To study the clinical and follow-up data of unilateral two-channel endoscopic system and percutaneous large-channel endoscopic system in the treatment of lumbar degenerative diseases(LDD),and to compare the differences in clinical efficacy and complications of the two endoscopic lumbar fusion procedures.Methods Patients with lumbar degenerative diseases admitted to our hospital from January 2021 to January 2022 were selected for the study.A total of 52 patients were collected and divided into unilateral biportal endoscopic lumbar fusion(ULIF group)20 cases and Percutaneous endoscopic posterolateral transforaminal lumbar interbody fusion(Pe-PTLIF group)32 cases.Operation time,true total blood loss,length of hospital stay,postoperative incision and drainage,postoperative complications,hospitalization cost and perioperative blood biochemical indexes of the two groups were compared.Visual analogue scale/score(VAS),Oswestry disability index(ODI)and modified Mac Nab criteria were used to compare the efficacy of the two groups.Intervertebral disc height was measured and recorded at preoperative and last follow-up.IDH),Seg Mental lordosis SL,Lumber lordosis LL,dural sac cross-sectional area(DSCA),polyfidus adipose infiltration rate and polyfidus atrophy rate were used to evaluate recovery of lumbar lordosis,intervertebral height,dural sac cross-sectional area and multifidus muscle injury.Results Patients in both groups were followed up,with the mean follow-up time of ULIF group(12.5±1.2)months and Pe-PTLIF group(13.2±1.5)months.Operative time,true total blood loss and postoperative diversion volume in ULIF group were: [(181.2±22.4)min,(478.81±117.49)ml,(60.65±17.7)ml],Pe-PTLIF group [(207.28±24.89)min,(383.29±95.02)ml,(40.05±15.51)ml],respectively.The differences were statistically significant(P < 0.05).ULIF group hospitalization time,hospitalization costs were [(9.25±2.15)days,(5.78±0.78)million yuan],Pe-PTLIF group were [(8.56±2.75)days,(6.13±1.13)million yuan],the difference was not statistically significant.Preoperative CK,CRP,Hb between the two groups compared,the difference has no statistical significance(P > 0.05),but 1 day after surgery,3days after surgery Pe-PTLIF group of patients with serum CK,CRP mean and Hb difference and ULIF significantly reduced,the difference has statistical significance(P > 0.05).The VAS and ODI(%)scores of postoperative leg pain in 2 groups were significantly improved at each time point after surgery(P < 0.05).The VAS scores of lumbago 3 days after surgery and ODI(%)scores of Pe-PTLIF group 1 month after surgery were lower than those of ULIF group,and the differences were statistically significant.However,VAS score and ODI(%)score at 3and 6 months after surgery showed no significant difference between the two groups.At the last follow-up,the excellent and good rate of the modified Mac Nab standard was 90% in the Pe-PTLIF group and 87.5% in the ULIF group,and the difference was not statistically significant(P > 0.05).A total of 3 cases of surgery-related complications occurred in both groups,with an incidence of 5.7%.Among them,ULIF group and Pe-PTLIF group had 1 case of aggravated lower extremity symptoms after surgery,and Pe-PTLIF group 1 case of dural rupture.The intervertebral disc height(DH),segmental lordosis Angle(SL),lumbar lordosis Angle(LL)and dural sac cross-sectional area(DSCA)measured in 2 groups at the last follow-up after surgery were higher than those before surgery,the differences were statistically significant(P < 0.05).There was no significant difference in DH,SL,LL and DSCA between the two groups before surgery and at the last follow-up(P > 0.05).At the last follow-up,the polyfidus atrophy rates in ULIF group and Pe-PTLIF group were(11.1%±2.3%).(8.3%±3.7%),the difference was statistically significant(P < 0.05),ULIF group polyfidus fat infiltration score was greater than Pe-PTLIF group,the difference was statistically significant(P < 0.05);At the last follow-up,19 cases(95%)of the ULIF group had fusion,and 1 case had fusion trend but not complete fusion.In the Pe-PTLIF group,there were 29 cases(90.63%)of segmenfusion,2 cases with fusion trend but not complete fusion,and 1 case without segmenfusion,with no statistical significance between the two groups(P >0.05).Conclusion In the treatment of lumbar degenerative diseases,unilateral biportal endoscopic and percutaneous large channel endoscopic fusion can achieve good clinical efficacy,and the fusion rate of both is similar.In comparison,percutaneous large channel endoscopic fusion has less damage to muscle and other soft tissues,faster recovery,but longer operation time.The incidence of complications of the two endoscopic-assisted lumbar fusion is lower,and both are safe and effective surgical methods.