Unilateral biportal endoscopic decompression of the responsible segment versus posterior lumbar interbody fusion for de-generative spinal stenosis in the elderly
[Objective]To compare the clinical outcomes of unilateral biportal endoscopic(UBE)decompression of the responsible seg-ment versus posterior lumbar interbody fusion(PLIF)for degenerative spinal stenosis in the elderly.[Methods]A retrospective study was performed on 65 patients who underwent surgical treatment for lumbar spinal stenosis in our hospital from January 2018 to March 2021.Ac-cording to doctor-patient communication,28 patients received UBE decompression,while the other 37 patients received PLIF.The perioper-ative,follow-up and imaging results were compared between the two groups.[Results]Although there was no significant difference in opera-tion time between two groups,the UBE group was suprior to the PLIF group in terms of total incision length[(2.1±0.9)cm vs(11.2±1.12)cm,P＜0.05],intraoperative fluoroscopy times[(3.3±0.8)vs(5.9±1.2)times,P＜0.05],intraoperative blood loss[(36.2±10.2)ml vs(201.3±11.3)ml,P＜0.05],ambulation time[(22.7±5.1)days vs(40.2±8.5)days,P＜0.05]and hospital stay[(7.3±2.2)days vs(11.2±3.0)days,P＜0.05].The mean follow-up period lasted for(14.1±1.1)months,and the UBE group resumed full weight-bearing activity significantly earlier than the PLIF group[(4.3±2.8)weeks vs(10.6±3.4)weeks,P＜0.05].The VAS scores for low back pain and leg pain,as well as ODI scores significant-ly improved in both groups over time postoperatively(P＜0.05),which was not statistically significant between the two groups before surgery(P＞0.05).The UBE group was significantly better than the PLIF group regarding low back pain VAS score[(2.3±0.7)vs(2.8±0.9),P＜0.05],leg pain VAS score[(2.5±0.6)vs(2.9±0.7),P＜0.05],and ODI score[(20.6±3.3)vs(23.4±2.9),P＜0.05]3 months postoperatively,while which became not statistically significant between the two groups at latest follow up(P＞0.05).Regarding imaging,the lateral recess diameter and spinal canal cross-section significantly increased in both groups at the last follow-up,compared with those before surgery(P＜0.05),the lum-bar scoliotic Cobb angle remained unchanged significantly in the UBE group(P＞0.05),but decreased significantly in PLIF group(P＜0.05).There were no significant differences in lateral recess diameter,vertebral canal cross-sectional area and scoliotic Cobb angle between the two groups before surgery(P＞0.05),however,the PLIF group got significantly less scoliotic angle than the UBE group at the latest interview[(15.7±3.3)° vs(17.8±4.6)°,P＜0.05].[Conclusion]The unilateral biportal endoscopic decompression of the responsible segment has bene-fits of less trauma and better short-term clinical consequences over the traditional open PLIF for degenerative lumbar spinal stenosis in the elderly.
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