One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study

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Abstract

Background

The one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS).

Methods

One hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST).

Results

After PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) ( P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant ( P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups ( P > 0.05). However, all clinical and functional scores significantly improved postoperatively ( P < 0.05). Postoperative DCSA of both groups was significantly found to be improved ( P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference ( P = 0.713).

Conclusion

OSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.

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Most cited references 34

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Mean Difference, Standardized Mean Difference (SMD), and Their Use in Meta-Analysis: As Simple as It Gets.

Chittaranjan Andrade (2020)

In randomized controlled trials (RCTs), endpoint scores, or change scores representing the difference between endpoint and baseline, are values of interest. These values are compared between experimental and control groups, yielding a mean difference between the experimental and control groups for each outcome that is compared. When the mean difference values for a specified outcome, obtained from different RCTs, are all in the same unit (such as when they were all obtained using the same rating instrument), they can be pooled in meta-analysis to yield a summary estimate that is also known as a mean difference (MD). Because pooling of the mean difference from individual RCTs is done after weighting the values for precision, this pooled MD is also known as the weighted mean difference (WMD). Sometimes, different studies use different rating instruments to measure the same outcome; that is, the units of measurement for the outcome of interest are different across studies. In such cases, the mean differences from the different RCTs cannot be pooled. However, these mean differences can be divided by their respective standard deviations (SDs) to yield a statistic known as the standardized mean difference (SMD). The SD that is used as the divisor is usually either the pooled SD or the SD of the control group; in the former instance, the SMD is known as Cohen's d, and in the latter instance, as Glass' delta. SMDs of 0.2, 0.5, and 0.8 are considered small, medium, and large, respectively. SMDs can be pooled in meta-analysis because the unit is uniform across studies. This article presents and explains the different terms and concepts with the help of simple examples.

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Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study.

H. Weber, B Magnaes, T Amundsen … (2000)

A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years. To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors for the treatment result can be defined. Surgical decompression has been considered the rational treatment. However, clinical experience indicates that many patients do well with conservative treatment. In this study, 19 patients with severe symptoms were selected for surgical treatment and 50 patients with moderate symptoms for conservative treatment, whereas 31 patients were randomized between the conservative (n = 18) and surgical (n = 13) treatment groups. Pain was decisive for the choice of treatment group. All patients were observed for 10 years by clinical evaluation and questionnaires. The results, evaluated by patient and physician, were rated as excellent, fair, unchanged, or worse. After a period of 3 months, relief of pain had occurred in most patients. Some had relief earlier, whereas for others it took 1 year. After a period of 4 years, excellent or fair results were found in half of the patients selected for conservative treatment, and in four fifths of the patients selected for surgery. Patients with an unsatisfactory result from conservative treatment were offered delayed surgery after 3 to 27 months (median, 3.5 months). The treatment result of delayed surgery was essentially similar to that of the initial group. The treatment result for the patients randomized for surgical treatment was considerably better than for the patients randomized for conservative treatment. Clinically significant deterioration of symptoms during the final 6 years of the follow-up period was not observed. Patients with multilevel afflictions, surgically treated or not, did not have a poorer outcome than those with single-level afflictions. Clinical or radiologic predictors for the final outcome were not found. There were no dropouts, except for 14 deaths. The outcome was most favorable for surgical treatment. However, an initial conservative approach seems advisable for many patients because those with an unsatisfactory result can be treated surgically later with a good outcome.

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Management of lumbar spinal stenosis

Jon Lurie, Christy Tomkins-Lane (2016)

Lumbar spinal stenosis (LSS) affects more than 200 000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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Author and article information

Contributors

Yu Ding:

ORCID: http://orcid.org/0000-0002-6306-3768

cosmos_dingyu@163.com

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 22 April 2024

Publication date PMC-release: 22 April 2024

Publication date Collection: 2024

Volume: 19

Electronic Location Identifier: 254

Affiliations

[1 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Orthopedics of TCM Senior Department, , The Sixth Medical Center of PLA General Hospital, ; 6 Fucheng Road, Haidian District, Beijing, 100048 People’s Republic of China

[2 ]The Second School of Clinical Medicine, Southern Medical University, ( https://ror.org/01vjw4z39) Guangzhou, People’s Republic of China

[3 ]School of Medicine, South China University of Technology, ( https://ror.org/0530pts50) Guangzhou, People’s Republic of China

Author information

Tusheng Li http://orcid.org/0000-0001-6560-2123

Yu Ding http://orcid.org/0000-0002-6306-3768

Article

Publisher ID: 4743

DOI: 10.1186/s13018-024-04743-7

PMC ID: 11034078

PubMed ID: 38649974

SO-VID: d86d1395-cc7e-4792-a5a6-03f8b5540978

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 21 February 2024

Date accepted : 16 April 2024

Funding

Funded by: Research and Demonstration application of Clinical Diagnosis and Treatment Technology in Beijing

Award ID: Z191100006619028

Funded by: National Natural Science Fundation of China

Award ID: 82274637

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: one-hole split endoscope,unilateral biportal endoscopy,lumbar spinal stenosis,minimally invasive surgery,decompression

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ScienceOpen disciplines: Surgery

Keywords: one-hole split endoscope, unilateral biportal endoscopy, lumbar spinal stenosis, minimally invasive surgery, decompression

One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study

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Most cited references 34

Mean Difference, Standardized Mean Difference (SMD), and Their Use in Meta-Analysis: As Simple as It Gets.

Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study.

Management of lumbar spinal stenosis

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