[Early application of bilateral decompression under single channel endoscopic laminectomy in patients with adjacent vertebrae after lumbar fusion].

Abstract

Objective: To explore clinical effect of unilateral laminotomy for bilateral decompression (ULBD) under single channel endoscopic(Delta) in treating adjacent segment disease(ASD) after lumbar fusion.

Methods: A retrospective analysis of 24 patients who underwent spinal endoscopic ULBD after lumbar fusion was performed from January 2021 to January 2023, including 10 males and 14 females, aged from 54 to 77 years old with an average of (59.2±3.6) years old;2 patients with L_2,3, 16 patients with L_3,4, and 6 patients with L₅S₁. Operative time and intraoperative blood loss were recorded, visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded before oepration, 1 week, 1, 3 and 6 months after operation, respectively;the modified MacNab standard score evaluation was used to evaluate clinical effects.

Results: All patients were successfully completed operation without nerve injury or dural injury and cerebrospinal fluid leakage. Operation time was (90.3±11.8) min, intraoperative blood loss was (35.3±5.3) ml, and hospital stay was (14.4±2.1) d. All 24 patients were followed up for 6 months. ODI and VAS were improved from (51.25±5.48) % and (6.88±1.23) before operation to (9.29±1.76) % and (1.13±0.95) at one week after operation, respectively (P<0.05). ODI, VAS (9.17±1.90) % and(1.67±0.82), were improved at 1 month compared with 1 week after operation (P<0.05). There were no significant difference in postoperative ODI and VAS at 1, 3 and 6 months (P>0.05). At the latest follow-up, 8 patients got excellent result, 13 good, and 3 fair according to the modified MacNab standard.

Conclusion: ULBD under single channel endoscopy (Delta) has advantages of less trauma, less bleeding, short operation time, rapid postoperative recovery, and could receive satisfactory clinical effect.