Observation On The Early Efficacy Of Unilateral Biportalendoscopic Lumbar Interbody Fusion In The Treatment Of Lumbar Spinal Stenosis

Objective(s): The purpose of this study was to compare the early efficacy of unilateral biportal endoscopic lumbar interbody fusion(ULIF)and posterior transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar spinal stenosis,and to provide some reference value for the surgical decision of patients with lumbar spinal stenosis.Methods: Patients with lumbar spinal stenosis who underwent surgical treatment in our hospital from May 2021 to October 2022 were collected.The two surgical schemes were explained in detail to the patients before surgery.After signing the informed consent form for scientific research,the patient selected the surgical plan.The experimental group(ULIF)and the control group(TLIF)were treated with pedicle screw fixation after fusion.The perioperative indexes(operation time,estimated blood loss,postoperative ambulation time,hospitalization time),visual analogue scale(VAS),functional evaluation indexes(JOA score,ODI score,modified Macnab evaluation at 3 months after operation.)and postoperative complications were collected.Statistical analysis was performed by SPSS27.0software,and P < 0.05 was considered statistically significant.Results: All patients successfully completed the operation according to the surgical plan of their choice,without changing the operation.There were 26 cases in the experimental group,including 7 males and 19 females,aged from 42 to 74 years old.There were 28 cases in the control group,including 11 males and 17 females,aged from 44 to 78 years old.There was no significant difference in gender(P =0.336,P > 0.05),age(P = 0.777,P > 0.05)and weight(P = 0.273,P > 0.05)between the two groups.There was no significant difference in preoperative Hct value(P = 0.064,P > 0.05),VAS score(P = 0.607,P > 0.05),JOA score(P = 0.512,P >0.05)and ODI score(P = 0.262,P > 0.05)between the two groups.The estimated blood loss(P < 0.001)and postoperative ambulation time(P = 0.004,P < 0.05)in the experimental group were significantly better than those in the control group.The operation time(P = 0.001,P < 0.05)in the control group was shorter than that in the experimental group.There was no significant difference in hospital stay between the two groups(P = 0.133,P > 0.05).There were no blood transfusion cases in the experimental group,which was significantly better than 6 cases(21.43 %)in the control group(P = 0.012,P < 0.05).The VAS scores of the two groups of patients on the first day after surgery(P < 0.001),the second day after surgery(P = 0.006,P <0.05),the third day after surgery(P = 0.008,P < 0.05),and the first month after surgery(P = 0.014,P < 0.05).The experimental group was superior to the control group,and there was no significant difference in postoperative 3 months(P = 0.332,P > 0.05).There was no significant difference in JOA score between the two groups at 1 month after operation(P = 0.011,P< 0.05).There was no significant difference in ODI score between the two groups at 1 month after operation(P = 0.014,P< 0.05).The modified Macnab evaluation was followed up for 3 months after operation.In the experimental group,10 cases were excellent,15 cases were good,1 case was poor,and the excellent and good rate was 96.15 %.In the control group,10 cases were excellent,18 cases were good,and the excellent and good rate was 100 %.There was no significant difference in the excellent and good rate of modified Macnab evaluation between the two groups(P = 0.984,P> 0.05).The incidence of complications was 7.69 % in the experimental group and 10.71 % in the control group.There was no significant difference in the incidence of complications between the two groups(P = 0.702,P > 0.05).Conclusion(s): The application of ULIF and traditional TLIF in the treatment of patients with lumbar spinal stenosis can achieve satisfactory results in the early stage.ULIF has less trauma,mild postoperative short-term pain,and early postoperative ambulation,which is conducive to early rehabilitation of patients.The functional recovery of ULIF was better at 1 month after operation,and there was no significant difference in functional recovery at 3 months after operation.4.There was no significant difference in the overall incidence of complications between the two groups,but no postoperative infection occurred in the experimental group,and ULIF may reduce the risk of postoperative infection.