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.	谭芳, 李凯, 王健, 等. 单通道内镜下单侧入路双侧减压治疗退行性腰椎管狭窄症的疗效. 实用临床医药杂志, 2021, 25(20): 93-96.
5.	芦怀旺, 田霖, 胡鹏, 等. 单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析. 中华全科医学, 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.	谭芳, 谭江威, 王春晓, 等. 微创手术在退行性腰椎管狭窄症中的应用进展. 医学综述, 2021, 27(5): 967-972.
8.	郑超, 刘俊朋, 马炜, 等. 三角技术在脊柱单侧双通道内镜手术中的应用: 38例临床病例比较研究. 空军医学杂志, 2021, 37(5): 413-417.
9.	王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 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. 大通道内镜下单侧入路双侧减压与后入路椎板减压椎间融合治疗单节段腰椎管狭窄症的疗效分析. 扬州: 扬州大学, 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.	倪双洋, 张永远, 孙宏慧, 等. 单侧双通道脊柱内镜下手术治疗腰椎管狭窄症的并发症及处理措施的研究进展. 中国脊柱脊髓杂志, 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.	张玉红, 张民, 戴国华, 等. 单孔分体内镜治疗中重度腰椎管狭窄症的早期临床疗效. 中国脊柱脊髓杂志, 2023, 33(1): 37-44.
18.	徐浩严. 单侧双通道脊柱内镜与单通道脊柱内镜行ULBD治疗腰椎管狭窄症的疗效对比. 大连: 大连医科大学, 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.	刘昌震, 黄卫国, 李骥征, 等. 单孔分体内镜辅助后外侧入路腰椎椎体间融合术治疗L_4、5退变性腰椎滑脱症的临床疗效分析. 中国修复重建外科杂志, 2023, 37(8): 989-995.
22.	范祚然, 吴晓淋, 郭柱, 等. 单侧双通道脊柱内镜腰椎融合术与单通道脊柱内镜下经椎间孔腰椎融合术治疗合并椎间盘突出的腰椎管狭窄症疗效比较研究. 中国修复重建外科杂志, 2023, 37(9): 1098-1105.
23.	杨贺军, 牛旺, 唐骞, 等. 单侧双通道脊柱内镜技术治疗单节段胸椎黄韧带骨化症. 中国修复重建外科杂志, 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. 谭芳, 李凯, 王健, 等. 单通道内镜下单侧入路双侧减压治疗退行性腰椎管狭窄症的疗效. 实用临床医药杂志, 2021, 25(20): 93-96.
5. 芦怀旺, 田霖, 胡鹏, 等. 单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析. 中华全科医学, 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. 谭芳, 谭江威, 王春晓, 等. 微创手术在退行性腰椎管狭窄症中的应用进展. 医学综述, 2021, 27(5): 967-972.
8. 郑超, 刘俊朋, 马炜, 等. 三角技术在脊柱单侧双通道内镜手术中的应用: 38例临床病例比较研究. 空军医学杂志, 2021, 37(5): 413-417.
9. 王宁, 贝朝涌, 万健, 等. 单侧双通道脊柱内镜技术行腰椎椎间融合术学习曲线研究. 中国修复重建外科杂志, 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. 大通道内镜下单侧入路双侧减压与后入路椎板减压椎间融合治疗单节段腰椎管狭窄症的疗效分析. 扬州: 扬州大学, 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. 倪双洋, 张永远, 孙宏慧, 等. 单侧双通道脊柱内镜下手术治疗腰椎管狭窄症的并发症及处理措施的研究进展. 中国脊柱脊髓杂志, 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. 张玉红, 张民, 戴国华, 等. 单孔分体内镜治疗中重度腰椎管狭窄症的早期临床疗效. 中国脊柱脊髓杂志, 2023, 33(1): 37-44.
18. 徐浩严. 单侧双通道脊柱内镜与单通道脊柱内镜行ULBD治疗腰椎管狭窄症的疗效对比. 大连: 大连医科大学, 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. 刘昌震, 黄卫国, 李骥征, 等. 单孔分体内镜辅助后外侧入路腰椎椎体间融合术治疗L_4、5退变性腰椎滑脱症的临床疗效分析. 中国修复重建外科杂志, 2023, 37(8): 989-995.
22. 范祚然, 吴晓淋, 郭柱, 等. 单侧双通道脊柱内镜腰椎融合术与单通道脊柱内镜下经椎间孔腰椎融合术治疗合并椎间盘突出的腰椎管狭窄症疗效比较研究. 中国修复重建外科杂志, 2023, 37(9): 1098-1105.
23. 杨贺军, 牛旺, 唐骞, 等. 单侧双通道脊柱内镜技术治疗单节段胸椎黄韧带骨化症. 中国修复重建外科杂志, 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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