Abstract
Introduction: Open surgery, microscopy, micro-endoscopic laminotomy (MEL), and percutaneous stenosis lumbar decompression (PSLD) methods have been performed for spinal decompression. We aimed to verify the advantages and disadvantages of the novel technique unilateral biportal endoscopy (UBE). UBE includes the application of an arthroscope to the spine, and the surgery is performed while holding the triangle with both hands.
Methods: UBE was used as a posterior decompression method for a total of 64 cases: 56 cases of spinal canal stenosis, 3 cases of foraminal stenosis, and 5 cases of disc herniations. The surgeons stood on the left side of the patient, created a scopic portal for a 4-mm arthroscope at 1 cm above the disc level along the paraspinous process. From an 8-mm working portal to 2 cm of the caudal side, arthrocare was used for ablation and hemostasis of soft tissue, 4 mm diamond bar, curved Kerrison of various angles, dissectors, forceps, and other appropriate instruments.
Results: The operation time was initially approximately 2 hours, however, it later decreased to within 1 hour. There was no postoperative hematoma. VAS (Visual Analogue Scale) symptoms of the lower limb and low back pain significantly decreased. The satisfaction rate was 83% according to Macnab's evaluation. Two cases of dural rupture were repaired using the fibrin patch technique without significant neural damage.
Conclusions: The UBE method can be used to freely operate the target tissue without restriction by the outer-tube. The amount of bone resection is small because there is no limit to the range of use of the device. Various types of instruments can be used. The tip of the endoscope is close to the tissue, the capillaries are enlarged by approximately 70 times, and hemostasis can be carefully performed, so that the postoperative hematoma rate is low. Performing UBE with a clean view just under the lens with continuous water irrigation will be among the future decompression techniques.
