Comprehensive Analysis of UBE-Related Complications: Prevention and Management Strategies from 4685 Patients

The usefulness and utilisation of Lu's retractor for unilateral biportal endoscopic discectomy: a retrospective cohort study

BACKGROUND

A novel endoscopic instrument, Lu's retractor, was developed to address the recurrent issue of limited visualisation during unilateral biportal endoscopic (UBE) spinal surgery. Engineered to optimize the surgical field by mitigating soft tissue interference, this device aims to enhance operative precision and efficiency.

METHODS

This single-center retrospective cohort study analyzed 90 consecutive patients who underwent single-level lumbar discectomy via the UBE technique between June 2023 and June 2024. Based on the type of retractor utilised, patients were categorized into three groups: traditional retractor-assisted UBE discectomy (T-UBE), metal retractor-assisted UBE discectomy (M-UBE), and Lu's retractor-assisted UBE discectomy (Lu-UBE). Perioperative parameters-including operative duration, intraoperative blood loss, and complication incidence-along with clinical outcomes, were systematically recorded and compared to assess the relative efficacy of each retractor.

RESULTS

The Lu-UBE group exhibited significantly reduced hospital stays and intraoperative haemorrhage compared to the T-UBE and M-UBE cohorts. Furthermore, this group reported lower numerical rating scale (NRS) scores for both lumbar and radicular pain, alongside decreased Oswestry Disability Index (ODI) scores. Final follow-up assessments indicated superior Macnab grades, denoting improved functional recovery, and a lower incidence of postoperative complications.

CONCLUSION

Lu's retractor offers notable advantages over conventional and metal retractors in lumbar UBE discectomy by enhancing intraoperative visualization and minimizing complications. These findings support its potential utility as an effective alternative in minimally invasive spinal procedures.

Clinical efficacy of AUSS/UNSES-TLIF in the treatment of single-segment degenerative lumbar spinal stenosis: a retrospective study

OBJECTIVE

To explore the clinical efficacy and advantages of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS)-Transforaminal Lumbar Interbody Fusion (TLIF) in the treatment of degenerative lumbar spinal stenosis (LSS).

METHODS

This study included 71 patients with lumbar spinal stenosis who underwent surgical treatment at the Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, between January 2022 and December 2023. Among these, 34 patients underwent AUSS-TLIF surgery, and 37 patients underwent minimally invasive TLIF (MIS-TLIF) surgery. Preoperative and postoperative Visual Analog Scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI) scores, intervertebral disc height, anterior-posterior diameter of the canal (APDC), surgical-related parameters (such as operative time, intraoperative blood loss, postoperative drainage, postoperative C-reactive protein levels, and length of hospital stay), and surgical outcomes were compared and analyzed between the AUSS-TLIF and MIS-TLIF groups.

RESULTS

All 71 patients were followed up. There were no significant differences in preoperative VAS scores or ODI index between the AUSS-TLIF and MIS-TLIF groups (P > 0.05). Three days postoperatively, both groups showed significant reductions in back and leg symptoms, with VAS scores significantly lower than preoperatively (P < 0.05). However, the AUSS-TLIF group had lower VAS scores at 3 days and 3 months postoperatively compared to the MIS-TLIF group, with a statistically significant difference (P < 0.05). At 12 months postoperatively, there was no significant difference in VAS scores between the two groups (P > 0.05). Both groups showed significant improvement in lumbar function at 3 and 12 months postoperatively, with ODI scores significantly lower than preoperatively (P < 0.05). However, the AUSS-TLIF group had a significantly lower ODI score at 3 months postoperatively compared to the MIS-TLIF group (P < 0.05), with no significant difference at 12 months (P > 0.05). There were no significant differences in preoperative intervertebral disc height or APDC between the two groups (P > 0.05). CT scans at 12 months postoperatively showed a significant increase in intervertebral disc height and APDC in both groups compared to preoperative values (P < 0.05), with no significant difference between the groups (P > 0.05). The AUSS-TLIF group had lower surgical blood loss, postoperative drainage, and postoperative inflammatory markers compared to the MIS-TLIF group (P < 0.05), but the AUSS-TLIF group had a significantly longer operative time compared to the MIS-TLIF group (P < 0.05).

CONCLUSION

Both AUSS-TLIF and MIS-TLIF achieve good clinical outcomes, but AUSS-TLIF, as an endoscopic surgery with an open surgical concept, offers advantages including greater flexibility, smaller trauma, less blood loss, shorter operative time, and shorter hospital stay. It provides a better perioperative experience for patients.

One-hole split endoscopy versus unilateral biportal endoscopy for lumbar degenerative disease: a systematic review and meta-analysis of clinical outcomes and complications

BACKGROUND

This study aims to systematically review and conduct a meta-analysis to assess the clinical outcomes and complications associated with the one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) in the treatment of lumbar degenerative disease, thereby offering a reference for clinical decision-making.

METHODS

A comprehensive literature search was conducted utilizing databases such as PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Network, Wanfang Database, and China Biomedical Literature Database, in conjunction with specific search terms. The retrieved literature was subsequently screened according to stringent inclusion and exclusion criteria. Systematic reviews and meta-analyses were performed using Stata 15.1 software.

RESULTS

A total of 513 patients were included across five studies, comprising 246 patients in the OSE group and 267 patients in the UBE group. The findings of this meta-analysis indicated that the incision length in the OSE group was significantly shorter than that in the UBE group (SMD = - 1.92, 95%CI: -3.03 to -0.80, P = 0.001). However, no statistically significant differences were observed between the two groups regarding operative duration, intraoperative blood loss, length of hospital stay, Visual Analog Scale (VAS) scores at various postoperative time points, Oswestry Disability Index (ODI) values at various postoperative time points, rates of excellent and good outcomes, sagittal translation (ST), range of motion (ROM), and complication rates.

CONCLUSIONS

Both OSE and UBE techniques are considered safe and effective for the management of LDD, demonstrating comparable treatment outcomes. However, OSE techniques offer the advantages of smaller surgical incisions and potentially reduced trauma.

[Short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery via crossing midline approach in treatment of free lumbar disc herniation]

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).

Methods

Between 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 L 3, 4 in 4 cases, L 4, 5 in 5 cases, and L 5, S 1 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.

Results

All 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.

Conclusion

When 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.