Objective To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). MethodsBetween March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L3, 4 in 4 cases, L4, 5 in 5 cases, and L5, S1 in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. ResultsAll 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points (P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. ConclusionWhen using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Objective To compare the effectiveness of uniportal endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-level lumbar degenerative disease. Methods A retrospective analysis was conducted on 130 patients with single-level lumbar degenerative disease treated between January 2019 and December 2022. According to the surgical technique, patients were divided into the MIS-TLIF group (43 cases), the Endo-TLIF group (45 cases), and the UBE-TLIF group (42 cases). Baseline data, including age, gender, operated level, disease type, preoperative lower-extremity pain visual analogue scale (VAS) score, and Oswestry disability index (ODI), showed no significant difference among the three groups (P>0.05). Operation time, estimated intraoperative blood loss, postoperative hospital stays, and perioperative complications were recorded. Clinical symptoms were evaluated preoperatively and at 1 day, 1 month, 3 months, 1 year, and 2 years postoperatively using the lower-extremity pain VAS score and ODI. Interbody fusion was evaluated using the Suk method at 2 years postoperatively. Surgical outcomes and quality of life were assessed using the modified MacNab criteria and EuroQol-5 Dimensions (EQ-5D) at last follow-up. Results There was no significant difference in operation time among the three groups (P>0.05). The estimated intraoperative blood loss in MIS-TLIF group was the most, while that in Endo-TLIF group was the least, and there were significant differences among the three groups (P<0.05). The postoperative hospital stay was significantly shorter in the Endo-TLIF group and the UBE-TLIF group than in the MIS-TLIF group (P<0.05), while no significant difference was observed between the Endo-TLIF and UBE-TLIF groups (P>0.05). No serious complications, such as severe neurological injury or intervertebral space infection, occurred intraoperatively in any of the three groups. In the MIS-TLIF, Endo-TLIF, and UBE-TLIF groups, some patients experienced transient neurological dysfunction, minor dural tears, or delayed wound healing, respectively; however, there was no significant difference in the overall complication incidence among the three groups (9.30% vs 6.67% vs 7.14%, P>0.05). All patients in the three groups were followed up 24-36 months, with an average of 26.62 months. At all postoperative follow-up time points, both lower-extremity pain VAS scores and ODI in three groups significantly improved compared to the preoperative values (P<0.05). In intergroup comparisons, except that the VAS score at 1 day postoperatively in the Endo-TLIF group was significantly lower than that in the MIS-TLIF group (P<0.05), no significant difference was found in VAS scores or ODI among the three groups at the same follow-up time points (P>0.05). At 2 years postoperatively, the solid interbody fusion rate exceeded 92% in all three groups, and the excellent-to-good rate assessed by the modified MacNab criteria at last follow-up was greater than 90%. No significant difference was observed among the three groups in terms of interbody fusion status, surgical outcome grade, or EQ-5D score (P>0.05). Conclusion Endo-TLIF and UBE-TLIF achieve effectiveness and fusion rates comparable to those of MIS-TLIF for single-level lumbar degenerative disease, with advantages of less trauma, reduced blood loss, and faster recovery.
Objective To investigate the feasibility and effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via a single incision for the treatment of adjacent two-segmental lumbar disc herniation (LDH). Methods A retrospective analysis was performed on 33 adjacent two-segmental LDH patients treated with single-incision UNSES between June 2023 and May 2025, including 18 males and 15 females, with a mean age of 55.7 years (range, 28-74 years) and a mean disease duration of 11.2 months (range, 3-36 months). There were 4 cases of L3, 4, L4, 5 herniation and 29 cases of L4, 5 and L5, S1 herniation. Pfirrmann grade of disc degeneration was grade 3 in 24 segments, grade 4 in 39 segments, and grade 5 in 3 segments. Perioperative indicators were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were evaluated preoperatively and at 3 days, 3 and 6 months postoperatively. The modified MacNab criteria were used to assess patient satisfaction at last follow-up. Postoperative lumbar CT or MRI was applied to evaluate nerve root decompression. Lumbar lordosis angle and L3, 4, L4, 5, and L5, S1 segmental endplate angles on standing lateral X-ray films were measured to compare sagittal balance changes before operation and at last follow-up. Results The operation time was 70-126 minutes, with an average of 84.8 minutes; the incision length was 1.8-2.4 cm, with an average of 2.1 cm; the fluoroscopy frequency was 1-4 times, with an average of 2.2 times; and the hospital stay was 5-12 days, with an average of 7.6 days. All patients were followed up 6-24 months, with an average of 14.1 months. The incidence of complications was 6.1% (2/33), including 1 case of dural tear (<4 mm) required no suture and presented no cerebrospinal fluid leakage, and 1 case complete inferior articular process resection had no obvious low back pain during follow-up. No myeloid hypertension-like syndrome, nerve root injury, cerebrospinal fluid leakage, or intervertebral space infection occurred in other patients. VAS score of low back and leg pain and ODI at each time point after operation were lower than those before operation, and further decreased with time, and the differences between different time points were significant (P<0.05). According to the modified MacNab criteria, 19 cases were excellent, 10 cases were good, 4 cases were fair, and the excellent and good rate was 87.9%. Postoperative lumbar MRI showed that the herniated nucleus pulposus tissue had been removed in all patients, the cross-sectional area of the spinal canal was significantly increased, and the nerve root was not significantly compressed. At last follow-up, there was no significant difference in lumbar lordosis angle, L3, 4 endplate angle, L4, 5 endplate angle, and L5, S1 endplate angle when compared with those before operation (P>0.05). Conclusion Single-incision UNSES has the advantages of small trauma, high safety, flexible operation, and extensive decompression, which can effectively complete the removal of two adjacent segments herniated disc, and the effectiveness is satisfactory.