Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study.

BACKGROUND: Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. METHODS: The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. RESULTS: The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. CONCLUSIONS: Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.

[Anterior cervical hybrid surgical treatment for multilevel cervical spondylotic myelopathy].

OBJECTIVE: To evaluate the clinical results of anterior cervical discectomy and reconstruction with a self-locking cage and internal fixation with short segmental plate for multilevel cervical spondylotic myelopathy. METHODS: From January 2012 to June 2015, a total of 106 patients received anterior cervical discectomy and reconstruction with a self-locking cage and internal fixation with short segmental plate were followed up. There were 71 males and 35 females, aged from 42 to 74 years old with an average of(55.4±5.1) years. Three segments were involved in 82 cases and four segments in 24 cases. Operation time, blood loss, postoperative drainage, and hospitalization time were recorded. Visual analogue scale(VAS) and Japanese Orthopaedic Association Score (JOA) were analyzed before and after operation(including 5 days, 3, 6, 12 months after operation and final follow-up), and the JOA improvement rate was analyzed. The cervical lordosis and ROM were measured before and after operation(including the follow-up point above) by X-rays. The postoperative complications were recorded and analyzed as well. RESULTS: All the operations were successful. The average operative time was (126.2±25.1) min, and the amount of blood loss was (82.1±26.3) ml. All the patients were followed up from 12 to 48 months with an average of (30.4±10.5) months. The VAS score of neck pain and JOA score was significantly better from 6.11±1.54 and 9.22±2.42 preoperatively to 2.14±0.51 and 12.46±1.42 at 5 days post-operation, respectively(P<0.05). The improvement rate of JOA was (56.7±21.6)%, there was no statistically significant difference of VAS, JOA scores and the improvement rate of JOA at each time after operation (P>0.05). Postoperative cervical lordosis at 3 months was significantly improved from preoperative (11.5±6.8)° to (19.6±8.9)°(P<0.05), and it can keep satisfactory stability until final follow-up(P>0.05). Postoperative ROM at 3 months was significantly decreased from the preoperative (37.6±10.4)° to (18.2±5.9)°(P<0.05), but there was no significant change in the process of follow-up (P>0.05). All the complications such as dysphagia (19 cases), axial neck pain(6 cases), cerebral fluid leakage(3 cases), and hoarseness(2 cases), got better after conservative treatment. Three cases had intervertebral space non-fusion until final follow-up(without clinical symptom), but no loosening, breakage, or displacement of internal fixation were found. CONCLUSIONS: Anterior cervical discectomy, reconstruction with a self-locking cage and internal fixation with short segmental plate which can reduce intraoperative injury, restore cervical lordosis, improve neurological function and lower postoperative complications, it is an alternative treatment for multilevel cervical spondylotic myelopathy.