Objective To investigate the safety and effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of single-segment thoracic ossification of ligamentum flavum (TOLF). Methods Between August 2020 and December 2021, 11 patients with single-segment TOLF were treated with UBE technique. There were 6 males and 5 females, with an average of 58.2 years (range, 49-72 years). The responsible segment was T6, 7 in 1 case, T7, 8 in 1 case, T8, 9 in 2 cases, T9, 10 in 2 cases, T10, 11 in 2 cases, and T11, 12 in 3 cases. Imaging examination showed that the ossification were located on the left side in 4 cases, on the right side in 3 cases, and on bilateral sides in 4 cases. The main clinical symptoms were chest and back pain or lower limb pain, all accompanied by lower limb numbness and fatigue. The disease duration ranged from 2 to 28 months (median, 17 months). The operation time, postoperative hospital stay, and complications were recorded. Visual analogue scale (VAS) score was used to evaluate the chest and back pain and low limb pain, and Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score were used to evaluate functional recovery before operation and at 3 days, 1 month, 3 months after operation, and last follow-up. The anteroposterior diameter of the coronal spinal canal was measured by CT before and after operation to evaluate the effect of surgical decompression. Results All operations were successfully completed. The operation time was 50-105 minutes, with an average of 80.0 minutes. No postoperative complication such as dural sac tear, cerebrospinal fluid leakage, spinal nerve injury, or infection occurred. The postoperative hospital stay was 2-5 days, with an average of 3.1 days. All incisions healed by first intention. All patients were followed up 6-22 months, with an average of 14.8 months. CT measurement at 3 days after operation showed that the anteroposterior diameter of the spinal canal was (8.63±1.61) mm, which was significantly larger than that before operation [(3.67±1.37) mm] (t=−12.181, P<0.001). The VAS score of chest and back pain and lower limb pain and ODI at each time point after operation were significantly lower than those before operation (P<0.05). The above indexes were further improved after operation, except that there was no significant difference between at 3 months after operation and at last follow-up (P>0.05), the differences between other time points were significant (P<0.05). There was no recurrence during the follow-up period. Conclusion UBE technique is a safe and effective method to treat single-segment TOLF, but its long-term effectiveness needs to be further studied.
Objective To evaluate the clinical efficacy and safety of biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of recurrent lumbar disc herniation (RLDH). Methods The clinical data of patients with RLDH who underwent biportal endoscopic discectomy combined with annulus fibrosus suture using a single-use suture device at Mianyang Orthopaedic Hospital between May 2020 and July 2022 were retrospectively collected. Visual Analogue Scale (VAS) scores for low back and leg pain and Oswestry Disability Index (ODI) scores on postoperative Day 3 and at the last follow-up were used to assess pain and functional status. Postoperative lumbar CT, MRI, and dynamic X-rays were obtained to evaluate the extent of decompression, disc removal, and spinal stability. Clinical efficacy during follow-up was assessed using the MacNab criteria since postoperative 3 months. Results Twenty-one RLDH patients (16 males, 5 females) with a mean age of (45.14±15.26) years (range: 17-62 years) were included. The involved segments were L3-L4 in 1 case, L4-L5 in 9 cases, and L5-S1 in 11 cases. All surgeries were successfully completed without complications such as nerve injury, symptomatic epidural hypertension, dural tear, cerebrospinal fluid leakage, or infection. All patients were followed up for a mean duration of (11.38±3.51) months (range: 4-17 months). No recurrence of disc herniation or segmental instability was observed during follow-up. Significant improvements were seen in VAS scores for low back pain (2.90±0.70, 1.38±0.81), leg pain (2.33±0.58, 1.29±0.46), and ODI scores [(24.12±5.05)%, (11.29±1.86)%] on postoperative Day 3 and at the last follow-up compared to the preoperative values [5.90±1.09, 6.10±0.77, (57.08±9.72)%; all P<0.05]. According to the MacNab criteria, the clinical efficacy was rated as excellent in 16 cases, good in 3 cases, and fair in 2 cases, yielding an excellent-good rate of 90.5%. Conclusion Biportal endoscopic discectomy with annulus fibrosus suture is a safe and effective treatment for RLDH, demonstrating favourable clinical outcomes and warranting further research and application.
The current unilateral biportal endoscopy (UBE) technique was originated from Argentina and developed in South Korea, which was rapidly growing and popularizing in China. The adoption of spinal endoscopy, using small cameras placed inside body with continuous water irrigation, providing better surgical field with less tissue dissection and quicker recovery for patients. As with other disciplines, the use of spinal endoscopy in spinal surgery will become increasingly widespread. UBE technique will promote the popularization of spinal endoscopy in China with monoportal endoscopy technique. At the same time, biportal endoscopy has better expansibility, the application of accessory incision may provide solution for more complicated spinal disease. Chinese spine surgeon should better understand the trends in spinal endoscopy, seize the opportunity of the rapidly evolving in spinal healthcare, and to promote the popularization of UBE across the globe.
Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L1 in 2 cases, L2 in 4 cases, L3 in 3 cases, and L4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation (P<0.05), and further improved at last follow-up (P<0.05). The ASIA scale after operation significantly improved when compared with that before operation (P<0.05), and there was no significant difference (P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation (P<0.05), and without significant loss of correction during the follow-up (P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
ObjectiveTo compare the effectiveness and imaging features between implanting single and double Cage into intervertebral body through unilateral transforaminal lumbar interbody fusion (TLIF). MethodsThe clinical data were collected and analyzed from 104 patients who underwent unilateral TLIF between January 2013 and October 2014, who were divided into 2 groups:single Cage was implanted into intervertebral body in 64 cases (76 segments) in traditional group, and double Cage was implanted into intervertebral body in 56 cases (70 segments) in reformative group. There was no significant difference in age, gender, bone mineral density, operation segments between 2 groups (P>0.05). The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores were used to evaluate the effectiveness; the area of intervertebral bone-graft, fusion rate, height of intervertebral space, and the number of Cage subsidence were measured by CT scan. ResultsAll the patients were followed up 12.85 months on average (range, 9-15 months). The VAS, ODI, and JOA scores were significantly improved at each time point after operation when compared with preoperative values (P<0.05), and no significant difference was found between 2 groups (P>0.05) except VAS and ODI at 12 months after operation (P<0.05). However, the area of intervertebral bone-graft in reformative group[(5.94±1.17) cm2] was significantly larger than that in traditional group[(4.81±0.97) cm2] at 7 days after operation (t=-6.365, P=0.000). At 3 and 12 months after operation, the fusion rate was respectively 84.2% and 92.1% in traditional group and was respectively 88.6% and 94.3% in reformative group. Although the height of intervertebral space were increased when compared with preoperative height, the incidence rates of Cages subsidence in traditional group were 44.74% and 47.37% respectively at 3 and 12 months after operation and were significantly higher those that in reformative group (11.43% and 14.29% respectively) (P<0.05). In addition, the height difference between affected side and normal side in traditional group was significantly larger than that in reformative group (P<0.05). ConclusionBoth single and double Cage implanted into the intervertebral body through unilateral TLIF have good effectiveness. However, double Cage implanted into intervertebral body may hold the height of intervertebral space, reduce the incident rate of Cage subsidence, and prevent sagittal imbalance.
Objective To review the application and research progress of unilateral biportal endoscopy (UBE) technique in the treatment of lumbar related diseases. Methods The domestic and foreign literature on the application of UBE technique in the treatment of lumbar related diseases was extensively consulted, and the development history, clinical application, operation points and precautions, related complications and adverse reactions, advantages and disadvantages of the technique were reviewed. Results As a minimally invasive technique developed in recent years, UBE technique is effective in the treatment of lumbar spinal stenosis caused by different causes, with satisfactory decompression effect, less damage, and good lumbar stability. UBE technique has significant advantages over open surgery and microscopy-assisted surgery in the treatment of lumbar disc herniation. In the treatment of lumbar spondylolisthesis, the postoperative trauma of UBE technique is less than that of conventional surgery, and the fusion rate is satisfactory. There are also complications such as spinal cord injury, spinal epidural hematoma, incomplete decompression or recurrence, nerve root irritation symptoms, and postoperative infection in the treatment of lumbar related diseases with UBE technique. Detailed preoperative planning is essential for patients with lumbar related diseases who are suitable for UBE surgery. Conclusion UBE technique is easy to operate, has a gentle learning curve, can use conventional instruments, and has definite effectiveness. It is suitable for a variety of lumbar related diseases, but there are some defects and deficiencies.
Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH). Methods Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 ± 4.19, 69.70 ± 2.76, 59.50 ± 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the compl ications were used to evaluate the effectiveness. Results The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved heal ing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hyperthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hi ps (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 ± 4.84, 88.50 ± 8.13, and 78.00 ± 0.00 inpatients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, l ittle injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.
Objective To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS). Methods The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L2, 3 and L3, 4 in 2 cases, L3, 4 and L4, 5 in 29 cases, L4, 5 and L5, S1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated. Results All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation (P<0.05), while the LLA was not significantly different from that before operation (P=0.050). The CAC significantly improved (P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant (P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%. ConclusionUBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.
Objective To investigate the assessment and treatment methods for unilateral spatial agnosia as well as its influence on the functional recovery of patients after stroke, so as to comprehensively understand unilateral spatial agnosia and formulate an effective treatment plan to improve the effect of rehabilitation for stroke patients. Methods A total of 86 patients with unilateral spatial agnosia were analyzed and a pre-treatment and post-treatment comparison was done. Results Of the 86 patients, 21% suffered from unilateral spatial agnosia. The occurrence of unilateral spatial agnosia was related to the location of the stroke lesion. The treatment group witnessed significant improvement after rehabilitation training of correcting unilateral spatial agnosia (Plt;0.05). Conclusion The correct rehabilitation method is beneficial for an early improvement in a patient’s cognitive ability. This also lays a foundation for the recovery of function in their limbs.
Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy discectomy (UBED) versus percutaneous uniportal endoscopic interlaminar discectomy (PEID) for the treatment of single lumbar disc herniation (sLDH). Methods A retrospective analysis was conducted on 52 patients with sLDH who underwent UBED or PEID at the Affiliated Hospital of Southwest Medical University between January 2022 and June 2023. Surgical parameters, clinical outcomes, and imaging indicators were compared between the two groups. For normally distributed quantitative data, mean ± standard deviation was used for representation, while for non-normally distributed data, median (lower quartile, upper quartile) was used for representation. Results No significant difference was observed between the two groups in terms of gender, age, disease duration, affected segments, preoperative Visual Analogue Scale (VAS) scores for low back and leg pain, preoperative Oswestry Disability Index (ODI) scores, preoperative disc height ratio (DHR), or preoperative sagittal rotation angle (SRA) (P>0.05). All patients successfully underwent surgery. In the UBED group, one case of cerebrospinal fluid leakage and one case of pseudomeningocele syndrome occurred postoperatively. In the PEID group, two cases of pseudomeningocele syndrome occurred postoperatively, and one case of recurrence was observed 1.5 years after surgery. Both groups showed significant improvements in VAS scores for low back and leg pain and ODI scores postoperatively and during follow-up compared to preoperative values (P<0.05). Significant differences were found between the UBED and PEID groups in terms of operation time [(138.3±28.0) vs. (113.5±34.2) min], intraoperative blood loss [(58.6±24.4) vs. (45.7±20.3) mL], postoperative drainage volume [(48.7±16.9) vs. (30.0±13.4) mL], postoperative ambulation time [3.4 (3.0, 4.0) vs. 2.3 (2.0, 3.0) d], and VAS scores for low back pain on postoperative Day 1 (2.87±0.55 vs. 2.24±0.65) (P<0.05). No significant difference was observed in intraoperative fluoroscopy frequency, VAS scores for leg pain on postoperative Day 1, VAS scores for low back and leg pain 6 months and 1 year after operation, postoperative hospital stay, postoperative complication rates, ODI scores 1 year after operation, DHR 1 year after operation, SRA 1 year after operation, or MacNab evaluation 1 year after operation (P>0.05). Conclusions Both UBED and PEID are safe and effective treatments for sLDH, with similar complication rates and clinical outcomes. However, PEID demonstrates advantages in reducing soft tissue damage and accelerating perioperative recovery.