Clinical Comparison of Traditional Open Fusion Surgery and Unilateral Biportal Endoscopic Fusion for the Treatment of Lumbar Spinal Stenosis

Songlin Li; Chunying Wei

doi:10.54097/5xr83q25

Authors

Songlin Li
Chunying Wei

DOI:

https://doi.org/10.54097/5xr83q25

Keywords:

Lumbar Spinal Stenosis, Unilateral Biportal Endoscopic Technique, Degenerative Spinal Diseases, Minimally Invasive Surgery, Spinal Fusion Surgery

Abstract

Objective: To compare the clinical efficacy of traditional open fusion surgery and unilateral biportal endoscopic surgery in treating lumbar spinal stenosis, and to provide a reference for clinicians in choosing the surgical approach. Methods: This study retrospectively analyzed the clinical data of 80 patients with lumbar spinal stenosis who underwent surgery at Yulin Red Cross Hospital from January 2020 to February 2024. The patients were divided into two groups: one group underwent traditional open fusion surgery, while the other group underwent unilateral biportal endoscopic spine surgery. The study compared the general clinical data of the two groups, as well as various perioperative data, including surgical time, blood loss, postoperative drainage volume, serum inflammatory markers, short-term and long-term complications, and patient satisfaction with the surgical procedures. Conclusion: (1) UBE has demonstrated its advantages, such as precise positioning, small incisions, minimal bleeding, reduced postoperative pain, higher patient satisfaction, and shortened hospital stay for patients.(2) Traditional open fusion provides a larger surgical field and operating space during the procedure. However, the extensive exposure, long incisions, and prolonged recovery time are its drawbacks.(3) In clinical decision-making, individual patient differences, the complexity of the condition, and medical resources should be comprehensively considered. The choice of surgical method should take into account multiple factors to achieve the best clinical outcomes.

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References

[1] Kreiner, D.S., et al., An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013. 13(7): p. 734-43.

[2] Katz, J.N., et al., Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA, 2022. 327(17): p. 1688-1699.

[3] Shamji, M.F., et al., Management of Degenerative Lumbar Spinal Stenosis in the Elderly. Neurosurgery, 2015. 77 Suppl 4: p. S68-74.

[4] Ghogawala, Z., et al., Laminectomy Plus Fusion Versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med, 2016. 374(15): p. 1424-34.

[5] Shahi, P., et al., Comparison of Robotics and Navigation for Clinical Outcomes After Minimally Invasive Lumbar Fusion. Spine (Phila Pa 1976), 2023. 48(19): p.1342-1347.

[6] Kreiner, D.S., et al., An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 2013. 13(7): p. 734-43.

[7] Passias, P.G., et al., A cost-benefit analysis of increasing surgical technology in lumbar spine fusion. Spine J, 2021. 21(2): p. 193-201.

[8] He, D., et al., Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis. World Neurosurg, 2023. 173: p. e509-e520.

[9] Sun, C., et al., Role of unilateral partial facet joint preservation in postero-lateral approach lumbar interbody fusion for patients with degenerative lumbar spinal stenosis presenting bilateral lower limb symptoms: a retrospective study. J Orthop Surg Res, 2024. 19(1): p. 537.

[10] Antonacci, C.L., et al., A narrative review of endoscopic spine surgery: history, indications, uses, and future directions. J Spine Surg, 2024. 10(2): p. 295-304.

[11] Wang, X., et al., Bibliometric analysis of transforaminal lumbar interbody fusion: research status, trends, and future directions. EFORT Open Rev, 2023. 8(12): p.906-918.

[12] Phan, K. and R.J. Mobbs, Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976), 2016. 41(2): p. E91-E100.

[13] Sun, C., et al., Role of unilateral partial facet joint preservation in postero-lateral Approach to lumbar interbody fusion for patients with degenerative lumbar spinal stenosis presenting bilateral lower limb symptoms: a retrospective study. J Orthop Surg Res, 2024. 19(1): p. 537.

[14] Jang, J.W., D.G. Lee and C.K. Park, Rationale and Advantages of Endoscopic Spine Surgery. Int J Spine Surg, 2021. 15(suppl 3): p. S11-S20.

[15] Yu, Q., et al., Unilateral biportal endoscopic transforaminal lumbar interbody fusion versus conventional interbody fusion for the treatment of degenerative lumbar spine disease: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 2023. 24(1): p. 838.

[16] He, D., et al., Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis. World Neurosurg, 2023. 173: p. e509-e520.

[17] Kim, S.K., Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results. Medicina (Kaunas), 2024, 60(3).

[18] Deyo, R.A., et al., Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA, 2010. 303(13): p. 1259-65.

[19] Zheng, C.F., et al., Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases. OrthopSurg, 2016.8(4): p. 447-453.

[20] Hutchins, J., et al., A systematic review of validated classification systems for cervical and lumbar spinal foraminal stenosis based on magnetic resonance imaging. Eur Spine J, 2022. 31(6): p. 1358-1369.

[21] Phan, K. and R.J. Mobbs, Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976), 2016. 41(2): p. E91-E100.

[22] Kim, S.K., Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results. Medicina (Kaunas), 2024, 60(3).

[23] Jermy, J.E., et al., Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review. Eur Spine J, 2020. 29(6): p. 1318-1327.

[24] Zhu, M.T., et al., Mapping knowledge structure and themes trends in unilateral biportal endoscopic spine surgery: A bibliometric analysis. Front Surg, 2022. 9: p. 976708.

[25] Wang, H., et al., Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study. J Orthop Surg Res, 2021. 16(1): p. 559.

[26] He, D., et al., Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis. World Neurosurg, 2023. 173: p. e509-e520.

[27] Kreiner, D.S., et al., The mild(R) procedure: a systematic review of the current literature. Pain Med, 2014. 15(2): p. 196-205.

[28] Forsth, P., et al., A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med, 2016. 374(15): p. 1413-23.

[29] Yan g, L.H., et al., Lumbar decompression and lumbar interbody fusion in the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore), 2020. 99(27): p. e20323.

[30] Ghogawala, Z., et al., Laminectomy Plus Fusion Versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med, 2016. 374(15): p. 1424-34.

[31] Passias, P.G., et al., A cost-benefit analysis of increasing surgical technology in lumbar spine fusion. Spine J, 2021. 21(2): p. 193-201.

[32] Xu, D., et al., Unilateral decompressive laminectomy plus fusion using unilateral Biportal endoscopic technique for single-level lumbar spinal stenosis. Asian J Surg, 2024. 47(8): p. 3457-3463.

[33] Shahi, P., et al., Comparison of Robotics and Navigation for Clinical Outcomes After Minimally Invasive Lumbar Fusion. Spine (Phila Pa 1976), 2023. 48(19): p.1342-1347.

[34] Sivaganesan, A., et al., Advanced Technologies for Outpatient Lumbar Fusion: Barriers and Opportunities. Int J Spine Surg, 2022. 16(S2): p. S37-S43.