Objective To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). MethodsBetween March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L3, 4 in 4 cases, L4, 5 in 5 cases, and L5, S1 in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. ResultsAll 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points (P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. ConclusionWhen using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Objective To compare the effectiveness of uniportal endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-level lumbar degenerative disease. Methods A retrospective analysis was conducted on 130 patients with single-level lumbar degenerative disease treated between January 2019 and December 2022. According to the surgical technique, patients were divided into the MIS-TLIF group (43 cases), the Endo-TLIF group (45 cases), and the UBE-TLIF group (42 cases). Baseline data, including age, gender, operated level, disease type, preoperative lower-extremity pain visual analogue scale (VAS) score, and Oswestry disability index (ODI), showed no significant difference among the three groups (P>0.05). Operation time, estimated intraoperative blood loss, postoperative hospital stays, and perioperative complications were recorded. Clinical symptoms were evaluated preoperatively and at 1 day, 1 month, 3 months, 1 year, and 2 years postoperatively using the lower-extremity pain VAS score and ODI. Interbody fusion was evaluated using the Suk method at 2 years postoperatively. Surgical outcomes and quality of life were assessed using the modified MacNab criteria and EuroQol-5 Dimensions (EQ-5D) at last follow-up. Results There was no significant difference in operation time among the three groups (P>0.05). The estimated intraoperative blood loss in MIS-TLIF group was the most, while that in Endo-TLIF group was the least, and there were significant differences among the three groups (P<0.05). The postoperative hospital stay was significantly shorter in the Endo-TLIF group and the UBE-TLIF group than in the MIS-TLIF group (P<0.05), while no significant difference was observed between the Endo-TLIF and UBE-TLIF groups (P>0.05). No serious complications, such as severe neurological injury or intervertebral space infection, occurred intraoperatively in any of the three groups. In the MIS-TLIF, Endo-TLIF, and UBE-TLIF groups, some patients experienced transient neurological dysfunction, minor dural tears, or delayed wound healing, respectively; however, there was no significant difference in the overall complication incidence among the three groups (9.30% vs 6.67% vs 7.14%, P>0.05). All patients in the three groups were followed up 24-36 months, with an average of 26.62 months. At all postoperative follow-up time points, both lower-extremity pain VAS scores and ODI in three groups significantly improved compared to the preoperative values (P<0.05). In intergroup comparisons, except that the VAS score at 1 day postoperatively in the Endo-TLIF group was significantly lower than that in the MIS-TLIF group (P<0.05), no significant difference was found in VAS scores or ODI among the three groups at the same follow-up time points (P>0.05). At 2 years postoperatively, the solid interbody fusion rate exceeded 92% in all three groups, and the excellent-to-good rate assessed by the modified MacNab criteria at last follow-up was greater than 90%. No significant difference was observed among the three groups in terms of interbody fusion status, surgical outcome grade, or EQ-5D score (P>0.05). Conclusion Endo-TLIF and UBE-TLIF achieve effectiveness and fusion rates comparable to those of MIS-TLIF for single-level lumbar degenerative disease, with advantages of less trauma, reduced blood loss, and faster recovery.