Analysis of effectiveness of one-hole split endoscopy technique in treatment of lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TAN Fang ,  ZHANG Feng , HAN Shuai , SONG Xin , YUAN Yunhua ,  WANG Jian

Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China;

Corresponding?author：

ZHANG Feng, Email: zhangfeng@shpdph.com; WANG Jian, Email: wangjian1@shpdph.com

Keywords：

One-hole split endoscopy technique; lumbar spinal stenosis; spinal canal decompression; minimally invasive surgery

DOI：

10.7507/1002-1892.202401042

Video：

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Objective To investigate the effectiveness of one-hole split endoscope (OSE) technique in the treatment of single segment lumbar spinal stenosis (LSS). Methods The clinical data of 32 single segment LSS patients treated with OSE technique for simple spinal canal decompression between January 2022 and December 2022, who met the selection criteria, were retrospectively analysed. There were 18 males and 14 females, the age ranged from 45 to 82 years, with an average of 65.1 years. The disease duration was 9-72 months, with an average of 34.9 months. The surgical segments included L_{3, 4} in 3 cases, L_{4, 5} in 19 cases, and L₅, S₁ in 10 cases. The incision length, operation time, intraoperative blood loss, intraoperative radiation exposure frequency, postoperative mobilization time, and the area of the patient’s lesion segment dural sac before operation and at 1 month after operation were recorded. Low back pain and leg pain were assessed by visual analogue scale (VAS) score before operation and at 3 days, 3 months, and 12 months after operation; functional recovery was assessed by Oswestry disability index (ODI) before operation and at 3 months and 12 months after operation; the effectiveness was assessed by modified MacNab criteria at last follow-up. Results All 32 patients successfully completed the operation, with an average incision length of 2.05 cm, an average operation time of 88.59 minutes, an average intraoperative blood loss of 46.72 mL, an average intraoperative radiation exposure frequency of 3.84 times, and an average postoperative mobilization time of 11.66 hours. All patients were followed up 12-16 months, with an average of 13.5 months. One patient experienced lower limb numbness, pain, and decreased muscle strength after operation, while the remaining patients did not experience complications such as dural tear or important nerve damage. The VAS scores of low back pain and leg pain and ODI in patients at various time points after operation were significantly better than preoperative ones, and each indicator further improved with time. The differences between time points were significant (P<0.05). At 1 month after operation, the area of the patient’s lesion segment dural sac was (123.13±19.66) mm², which significantly increased compared to preoperative (51.25±9.50) mm² (t=?18.616, P<0.001). At last follow-up, the improved MacNab criteria were used to evaluate the effectiveness, with 18 cases achieving excellent results, 11 cases being good, and 3 cases being fair, with an excellent and good rate of 90.6%. Conclusion The effectiveness of using OSE technique for simple spinal canal decompression treatment of single segment LSS is satisfactory, with the advantages of minimal surgical trauma and fast recovery.

Citation： TAN Fang, ZHANG Feng, HAN Shuai, SONG Xin, YUAN Yunhua, WANG Jian. Analysis of effectiveness of one-hole split endoscopy technique in treatment of lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 337-341. doi: 10.7507/1002-1892.202401042 Copy

1.	Dijkerman ML, Overdevest GM, Moojen WA, et al. Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review. Eur Spine J, 2018, 27(7): 1629-1643.
2.	Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
3.	Lafian AM, Torralba KD. Lumbar spinal stenosis in older adults. Rheum Dis Clin North Am, 2018, 44(3): 501-512.
4.	譚芳, 李凱, 王健, 等. 單通道內鏡下單側入路雙側減壓治療退行性腰椎管狹窄癥的療效. 實用臨床醫藥雜志, 2021, 25(20): 93-96.
5.	蘆懷旺, 田霖, 胡鵬, 等. 單側雙通道內鏡治療單責任節段腰椎管狹窄癥的短期臨床療效分析. 中華全科醫學, 2023, 21(3): 413-416.
6.	Park SM, Park J, Jang HS, et al. Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial. Spine J, 2020, 20(2): 156-165.
7.	譚芳, 譚江威, 王春曉, 等. 微創手術在退行性腰椎管狹窄癥中的應用進展. 醫學綜述, 2021, 27(5): 967-972.
8.	鄭超, 劉俊朋, 馬煒, 等. 三角技術在脊柱單側雙通道內鏡手術中的應用: 38例臨床病例比較研究. 空軍醫學雜志, 2021, 37(5): 413-417.
9.	王寧, 貝朝涌, 萬健, 等. 單側雙通道脊柱內鏡技術行腰椎椎間融合術學習曲線研究. 中國修復重建外科雜志, 2022, 36(10): 1229-1233.
10.	Macnab I. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
11.	Masuda K, Oegema TR, An HS. Growth factors and treatment of intervertebral disc degeneration. Spine (Phila Pa 1976), 2004, 29(23): 2757-2769.
12.	Hussain Z. 大通道內鏡下單側入路雙側減壓與后入路椎板減壓椎間融合治療單節段腰椎管狹窄癥的療效分析. 揚州: 揚州大學, 2023.
13.	Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976), 2000, 25(11): 1424-1435.
14.	倪雙洋, 張永遠, 孫宏慧, 等. 單側雙通道脊柱內鏡下手術治療腰椎管狹窄癥的并發癥及處理措施的研究進展. 中國脊柱脊髓雜志, 2022, 32(7): 659-662.
15.	Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus, 2019, 46(5): E9.
16.	Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
17.	張玉紅, 張民, 戴國華, 等. 單孔分體內鏡治療中重度腰椎管狹窄癥的早期臨床療效. 中國脊柱脊髓雜志, 2023, 33(1): 37-44.
18.	徐浩嚴. 單側雙通道脊柱內鏡與單通道脊柱內鏡行ULBD治療腰椎管狹窄癥的療效對比. 大連: 大連醫科大學, 2021.
19.	Zhang Y, Feng B, Ning H, et al. One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique. J Orthop Surg Res, 2023, 18(1): 483.
20.	Zhang Y, Feng B, Hu P, et al. One-hole split endoscopy technique versus unilateral biportal endoscopy technique for L₅-S₁ lumbar disk herniation: analysis of clinical and radiologic outcomes. J Orthop Surg Res, 2023, 18(1): 668.
21.	劉昌震, 黃衛國, 李驥征, 等. 單孔分體內鏡輔助后外側入路腰椎椎體間融合術治療L_4、5退變性腰椎滑脫癥的臨床療效分析. 中國修復重建外科雜志, 2023, 37(8): 989-995.
22.	范祚然, 吳曉淋, 郭柱, 等. 單側雙通道脊柱內鏡腰椎融合術與單通道脊柱內鏡下經椎間孔腰椎融合術治療合并椎間盤突出的腰椎管狹窄癥療效比較研究. 中國修復重建外科雜志, 2023, 37(9): 1098-1105.
23.	楊賀軍, 牛旺, 唐騫, 等. 單側雙通道脊柱內鏡技術治療單節段胸椎黃韌帶骨化癥. 中國修復重建外科雜志, 2023, 37(2): 174-179.

1. Dijkerman ML, Overdevest GM, Moojen WA, et al. Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review. Eur Spine J, 2018, 27(7): 1629-1643.
2. Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
3. Lafian AM, Torralba KD. Lumbar spinal stenosis in older adults. Rheum Dis Clin North Am, 2018, 44(3): 501-512.
4. 譚芳, 李凱, 王健, 等. 單通道內鏡下單側入路雙側減壓治療退行性腰椎管狹窄癥的療效. 實用臨床醫藥雜志, 2021, 25(20): 93-96.
5. 蘆懷旺, 田霖, 胡鵬, 等. 單側雙通道內鏡治療單責任節段腰椎管狹窄癥的短期臨床療效分析. 中華全科醫學, 2023, 21(3): 413-416.
6. Park SM, Park J, Jang HS, et al. Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial. Spine J, 2020, 20(2): 156-165.
7. 譚芳, 譚江威, 王春曉, 等. 微創手術在退行性腰椎管狹窄癥中的應用進展. 醫學綜述, 2021, 27(5): 967-972.
8. 鄭超, 劉俊朋, 馬煒, 等. 三角技術在脊柱單側雙通道內鏡手術中的應用: 38例臨床病例比較研究. 空軍醫學雜志, 2021, 37(5): 413-417.
9. 王寧, 貝朝涌, 萬健, 等. 單側雙通道脊柱內鏡技術行腰椎椎間融合術學習曲線研究. 中國修復重建外科雜志, 2022, 36(10): 1229-1233.
10. Macnab I. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
11. Masuda K, Oegema TR, An HS. Growth factors and treatment of intervertebral disc degeneration. Spine (Phila Pa 1976), 2004, 29(23): 2757-2769.
12. Hussain Z. 大通道內鏡下單側入路雙側減壓與后入路椎板減壓椎間融合治療單節段腰椎管狹窄癥的療效分析. 揚州: 揚州大學, 2023.
13. Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976), 2000, 25(11): 1424-1435.
14. 倪雙洋, 張永遠, 孫宏慧, 等. 單側雙通道脊柱內鏡下手術治療腰椎管狹窄癥的并發癥及處理措施的研究進展. 中國脊柱脊髓雜志, 2022, 32(7): 659-662.
15. Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus, 2019, 46(5): E9.
16. Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
17. 張玉紅, 張民, 戴國華, 等. 單孔分體內鏡治療中重度腰椎管狹窄癥的早期臨床療效. 中國脊柱脊髓雜志, 2023, 33(1): 37-44.
18. 徐浩嚴. 單側雙通道脊柱內鏡與單通道脊柱內鏡行ULBD治療腰椎管狹窄癥的療效對比. 大連: 大連醫科大學, 2021.
19. Zhang Y, Feng B, Ning H, et al. One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique. J Orthop Surg Res, 2023, 18(1): 483.
20. Zhang Y, Feng B, Hu P, et al. One-hole split endoscopy technique versus unilateral biportal endoscopy technique for L₅-S₁ lumbar disk herniation: analysis of clinical and radiologic outcomes. J Orthop Surg Res, 2023, 18(1): 668.
21. 劉昌震, 黃衛國, 李驥征, 等. 單孔分體內鏡輔助后外側入路腰椎椎體間融合術治療L_4、5退變性腰椎滑脫癥的臨床療效分析. 中國修復重建外科雜志, 2023, 37(8): 989-995.
22. 范祚然, 吳曉淋, 郭柱, 等. 單側雙通道脊柱內鏡腰椎融合術與單通道脊柱內鏡下經椎間孔腰椎融合術治療合并椎間盤突出的腰椎管狹窄癥療效比較研究. 中國修復重建外科雜志, 2023, 37(9): 1098-1105.
23. 楊賀軍, 牛旺, 唐騫, 等. 單側雙通道脊柱內鏡技術治療單節段胸椎黃韌帶骨化癥. 中國修復重建外科雜志, 2023, 37(2): 174-179.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of effectiveness of one-hole split endoscopy technique in treatment of lumbar spinal stenosis

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