Comparative Study On The Efficacy Of Unilateral Biportal Endoscopic Fusion And Percutaneous Endoscopic Posterior Lumbar Interbody Fusion In The Treatment Of Single-segment Degenerative Lumbar Spinal Stenosis

Objective:In this study,patients with degenerative single-segment lumbar spinal stenosis were selected as subjects to compare and analyze the efficacy of unilateral biportal percutaneous lumbar interbody fusion or percutaneous endoscopic posterior lumbar interbody fusion from two aspects of clinical and imaging indexes.The purpose of this study is to provide reference for the selection of surgical methods and treatment of patients with DLSS Methods:In this study,patients with single segment DLSS who received PE-PLIF or UBE-LIF in the Spinal surgery Department of the third Hospital of Shanxi Medical University from May 2019 to January 2022 were divided into PE-PLIF group and UBE-LIF group according to the mode of operation.The visual analogue scales of waist and lower extremities and Oswestry disablity index(ODI)were calculated before operation,1 week,1 month,3 months,6 months and 12 months after operation.Perioperative indexes such as operation time,intraoperative blood loss and postoperative days under the ground were recorded.Imaging data such as lumbar lordosis angle(LL),segmental lordosis(SL),disc height(DH),spinal canal area,improvement rate of spinal canal area,fusion cage fusion and fusion cage settlement were measured and recorded before and after operation.To compare and evaluate the clinical efficacy and imaging results of two surgical methods in the treatment of single-segment lumbar spinal stenosis.The statistical analysis of all data is realized by software SPSS26.0.Results:In this study,a total of 128 patients with single-stage lumbar spinal stenosis who underwent UBE-LIF or PE-PLIF surgery were successfully operated and followed up by telephone and outpatient revisit.There was no significant difference in gender,age,BMI index,surgical segment and other baseline information between the two groups.The average operation time of UBE-LIF group was 214.18 ±53.48 min,and that of PE-PLIF group was 223.13 ±45.46 min,P > 0.05.There was no statistical difference in operation time between the two groups,and there was no significant difference in intraoperative blood loss between UBE-LIF group and PE-PLIF group.The postoperative landing time was 3.23 ±0.95 days in UBE-LIF group and 3.06 ±0.87 days in PE-PLIF group,P >0.05.There was no significant difference in postoperative ground landing time between the two groups,which confirmed that both UBE-LIF and PE-PLIF had the advantages of less trauma,quick recovery and short landing time.In terms of clinical curative effect,the clinical curative effect scores of the two groups were significantly improved compared with those before operation,and both UBE-LIF and PE-PLIF could decompress the nerves thoroughly,but during the follow-up one week after operation,the lumbar VAS score of the UBE-LIF group was 5.95 ±1.85,and the VAS score of the PE-PLIF group was 5.21 ±1.87,P < 0.05.The difference was statistically significant.There was no significant difference in waist VAS score,leg VAS score and ODI index in other periods of follow-up.In terms of imaging results,the average preoperative LL,SL,DH and spinal canal area of UBE-LIF group and PE-PLIF group were(35.03 ±9.87),(14.75 ±6.58),(7.94 ±1.20),(74.60 ±16.06)70.36 ±13.94,respectively.There was no significant difference between the two groups.The average postoperative LL,SL and DH of the two groups were(46.61 ±7.28),(12.56 ±5.11,12.10 ±4.65)and(12.51 ±1.70),respectively,P > 0.05.There was no significant difference in the postoperative spinal canal area between the two groups(124.85 ±13.46119.64 ±13.54),P < 0.05.There was significant difference between the two groups.The average postoperative improvement rate of spinal canal area in the two groups was(73.69% ±24.87)62.64 ±23.34,P <0.05.There was significant difference between the two groups.The fusion rate in UBE-LIF group was 91.8%,the fusion rate in PE-PLIF group was 91.1%,and the cage sedimentation rate in PELI group was 23.0%.There was no significant difference between the two groups(P > 0.05).Conclusion:For patients with single segmental DLSS,satisfactory clinical results can be obtained no matter UBE-LIF or PE-PLIF.Both methods have the advantages of less soft tissue injury,complete decompression and short time of going to the ground after operation.However,due to the existence of lumen formation in UBE-LIF operation,the VAS score of patients in the short term after operation is higher than that of PE-PLIF group.In terms of imaging results,both UBE-LIF group and PE-PLIF group can restore a certain height of lumbar kyphosis and intervertebral space;both UBE-LIF group and PE-PLIF group can effectively expand the spinal canal volume,but the effect of UBE-LIF group is more significant.