双侧同步UBE用于单侧椎板切开和双侧减压，作为治疗两级腰椎管狭窄症的潜在有效微创方法-动脉网

Bilateral synchronous UBE for unilateral laminotomy and bilateral decompression as a potentially effective minimally Invasive approach for two-level lumbar spinal stenosis

Nature 等信源发布 2025-01-20 11:57

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可切换为仅中文

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Currently, Unilateral biportal endoscopy is widely used in the surgical treatment of lumbar spinal stenosis. To investigate the feasibility of bilateral synchronous UBE to unilateral laminotomy and bilateral decompression(BS-UBE-ULBD) for treating two-level lumbar spinal stenosis (LSS). Sixty-four patients with two-level lumbar spinal stenosis (LSS) treated with BS-UBE-ULBD from October 2022 to January 2024 were retrospectively analyzed.

目前，单侧双门静脉内窥镜广泛用于腰椎管狭窄症的手术治疗。探讨双侧同步UBE单侧椎板切开减压（BS-UBE-ULBD）治疗二节段腰椎管狭窄症（LSS）的可行性。。

All patients were treated with BS-UBE-ULBD. All 64 patients successfully underwent surgery, and the duration of surgery was 95–180 min, with an average of 119.92 ± 14.79 min. The average number of fluoroscopy was 3.02 ± 0.92. The average blood loss during the surgery was 73. 44 ± 36.70 ml. Postoperative lumbar CT showed that the spinal canal and bilateral nerve roots were fully decompressed.

所有患者均接受BS-UBE-ULBD治疗。所有64例患者均成功接受手术，手术时间为95-180分钟，平均119.92±14.79分钟。平均透视次数为3.02±0.92。手术期间平均失血量为73。44±36.70毫升。术后腰椎CT显示椎管和双侧神经根完全减压。

There were no postoperative complications, such as infection, severe nerve root injury, and lumbar instability. Complete follow-up data were obtained for all 64 cases. The VAS score of low back and leg pain and the ODI of lumbar function significantly (.

没有术后并发症，如感染，严重的神经根损伤和腰椎不稳。所有64例患者均获得了完整的随访数据。腰腿痛的VAS评分和腰椎功能的ODI显着（。

< 0.05) improved at each follow-up time point. MacNab evaluation at 6 months after the surgery showed that the results were excellent in 48 cases, good in 14 cases, and fair in 2 cases. The excellent and good rate was 96. 88% (62/64). So BS-UBE-ULBD is a minimally invasive, highly effective, and safe procedure for 2-level LSS..

<0.05）在每个随访时间点均有改善。术后6个月MacNab评估显示，优48例，良14例，可2例。优良率为96。88%（62/64）。因此，BS-UBE-ULBD是一种微创，高效，安全的2级LSS手术。。

Degenerative lumbar spinal stenosis (LSS) refers to clinical symptoms caused by the compression of the cauda equina, nerve root, and vascular complex. LSS can occur due to the abnormal shape and volume of the bony or fibrous structure after degenerative changes and the stenosis of the inner diameter of one or more lumens at a single level or multiple levels.

。LSS可能是由于退行性改变后骨或纤维结构的形状和体积异常以及单个或多个管腔的内径狭窄所致。

It is a common cause of lumbago or lumbago and leg pain, which is common among middle-aged and elderly people.

它是腰痛或腰腿痛的常见原因，在中老年人中很常见。

. LSS has become the most common cause of lumbar surgery among patients over 60 years of age

。LSS已成为60岁以上患者腰椎手术的最常见原因

. However, traditional surgery necessitates extensive stripping of paraspinal muscles, which can easily lead to the ischemic injury of paraspinal muscles and atrophy after denervation. Therefore, traditional surgery may result in intractable back pain, stiffness, and discomfort after surgery

然而，传统手术需要广泛剥离椎旁肌，这很容易导致椎旁肌的缺血性损伤和去神经支配后的萎缩。因此，传统手术可能会导致术后顽固性背痛，僵硬和不适

. Furthermore, as the posterior bone and soft tissue structures need to be extensively resected during the surgery, epidural scar and nerve compression are highly likely after the surgery. The high risk of general anesthesia cannot be ignored among elderly and weak patients

此外，由于手术期间需要广泛切除后部骨骼和软组织结构，因此手术后很可能出现硬膜外瘢痕和神经压迫。

Recently, with the rapid development of minimally invasive spine surgery, endoscopic surgery has been applied in the treatment of LSS

近年来，随着微创脊柱手术的迅速发展，内镜手术已被应用于LSS的治疗

. Unilateral biportal endoscopy (UBE ) is more popular in treating LSS and is a more flexible operation, with small trauma, quick recovery, and a gentle learning curve. In addition, many studies have proven the good clinical efficacy of unilateral biportal endoscopy

单侧双门静脉内窥镜检查（UBE）在治疗LSS方面更受欢迎，并且是一种更灵活的操作，创伤小，恢复快，学习曲线温和。此外，许多研究已经证明单侧双门静脉内窥镜检查具有良好的临床疗效

. Multilevel spinal stenosis can be done simultaneously. Previously, the same operator decompressed multiple segments in turn

多节段椎管狭窄可以同时进行。以前，同一个操作符依次解压缩多个段

, but the operation lasted longer, and the corresponding problems, such as bleeding, high risk of anesthesia, and fluoroscopy frequency, increased.

，但手术持续时间更长，相应的问题，如出血，麻醉风险高，透视频率增加。

From October 2022 to June 2024, our hospital pioneered the use of Bilateral Synchronous UBE-unilateral Laminotomy and Bilateral Decompression (BS-UBE-ULBD) for two-level degenerative LSS. Sixty-four patients with two-segment LSS were treated with BS-UBE-ULBD, and the results were satisfactory.

从2022年10月到2024年6月，我们医院率先使用双侧同步UBE单侧椎板切开术和双侧减压（BS-UBE-ULBD）治疗两级退行性LSS。用BS-UBE-ULBD治疗64例两段LSS患者，结果令人满意。

Data and method

数据和方法

General information

一般信息

A retrospective analysis was performed on 65 patients with bilevel LSS admitted to our hospital (Qilu Hospital of Shandong University, Jinan) between October 2022 and January 2024.They were treated with UBE-ULBD under double-channel endoscopy on both sides. There were 34 males and 31 females, aged 57–82 years, with an average age of (66.88 ± 6.42) years, and the disease course lasted 6–120 months (mean ± SD: 36.13 ± 25.77 months).

回顾性分析2022年10月至2024年1月我院（山东大学齐鲁医院，济南）收治的65例双水平LSS患者。他们在双侧双通道内镜下接受UBE-ULBD治疗。男性34例，女性31例，年龄57-82岁，平均年龄（66.88±6.42）岁，病程6-120个月（平均SD：36.13±25.77个月）。

One patient died of respiratory failure due to the novel coronavirus pneumonia infection 5 months after the operation and was lost to follow-up. All patients were given symptomatic treatment before the operation until there was no obvious surgical contraindication. The inclusion criteria were as follows: .

一名患者在手术后5个月因新型冠状病毒肺炎感染而死于呼吸衰竭，并失去了随访。所有患者术前均给予对症治疗，直至无明显手术禁忌症。纳入标准如下：。

①

the patients failed to respond to conservative treatment for more than 3 months;

患者对保守治疗的反应超过3个月；

②

the symptoms and signs were consistent with the results of imaging examination, and all of them were confirmed as double-segment LSS;

症状和体征与影像学检查结果一致，均确诊为双段LSS；

③

patients and their family members understood the complications of the operation and signed the informed consent form;

患者及其家属了解手术的并发症并签署了知情同意书；

④

the patients completed the follow-up process after the operation. The exclusion criteria were as follows:

患者在手术后完成了随访过程。排除标准如下：

①

patients with lumbar lesions affecting 3 or more segments;

腰椎病变影响3个或更多节段的患者；

②

patients with severe stenosis of intervertebral foramen;

；

③

patients with lumbar instability or lumbar spondylolisthesis above II °;

腰椎不稳或腰椎滑脱超过II°的患者；

④

patients with a history of lumbar surgery or infection, tumor, and severe systemic medical diseases.

有腰椎手术或感染史，肿瘤史和严重全身性疾病史的患者。

Method

方法

After successful general anesthesia, patients were placed in the prone position, and two sets of spinal UBE instruments were routinely prepared. The patient was placed in the prone position, and the bed surface was adjusted to make the target intervertebral space as vertical as possible relative to the ground.

全身麻醉成功后，将患者置于俯卧位，并常规准备两套脊柱UBE器械。将患者置于俯卧位，调整床面，使目标椎间隙尽可能垂直于地面。

The lesion site and the corresponding intervertebral space level were determined by fluoroscopy (Fig. .

通过透视确定病变部位和相应的椎间隙水平（图）。

, AB). Two operators treated one segment on each side of the patient, The two surgeons are from the same center, the same diagnosis and treatment team, and are doctors of the same level and level. and routinely incised with a sharp knife at the inner edge of the pedicle 1 cm from the spinous process and 1.5–2 cm above and below the intervertebral space.

，AB）。两名手术人员分别治疗患者两侧的一个节段，两名外科医生来自同一中心，同一诊断和治疗团队，并且是同一级别和级别的医生。并常规用锋利的刀在距棘突1厘米和椎间隙上下1.5-2厘米的椎弓根内边缘切开。

The endoscope and working channel were determined based on the surgeon’s left and right-hand operation habits (Fig. .

根据外科医生的左右手操作习惯确定内窥镜和工作通道（图）。

, AB). Operator’s station (Fig.

，AB）。操作员站（图。

, C); a serial dilator was used for insertion into the lamina. The working cannula was placed after removing the dilator. The vertebral plate was opened in the working channel for operation. Figure

，C）；使用连续扩张器插入椎板。取出扩张器后放置工作套管。在工作通道中打开椎板进行手术。图

,D shows the intraoperative anteroposterior fluoroscopic positioning view. Based on the location of the lesion, ipsilateral hemilaminectomy was conducted using a drill and a rongeur to expose the deep part of the ligamentum flavum. The drill and the rongeur were used to remove hypertrophic facet joints and lamina.

，D显示术中前后透视定位视图。根据病变的位置，使用钻头和咬骨钳进行同侧半椎板切除术，以暴露黄韧带的深部。钻头和咬骨钳用于去除肥大的小关节和椎板。

Then, the ligamentum flavum and the dural space were explored using a blunt hook to ensure that there was no adhesion. The ligament and nerve were stripped using a curette and a rongeur to decompress. For contralateral decompression, the midline of the spinal canal was first determined using a high-speed drill.

然后，使用钝钩探查黄韧带和硬脑膜间隙，以确保没有粘连。使用刮匙和咬骨钳剥离韧带和神经以减压。对于对侧减压，首先使用高速钻头确定椎管中线。

The range was then adjusted from the middle. Partial resection of the base of the spinous process prevented it from obstructing the operating range to ensure adequate working space. After exposure, the ligamentum was dissected from the contralateral lamina and cut. The contralateral approach was performed dorsally to the dura, keeping the ligamentum flavum intact.

然后从中间调整范围。棘突基部的部分切除阻止了它阻碍了手术范围，以确保足够的工作空间。。对侧入路在硬脑膜背侧进行，保持黄韧带完整。

The craniocaudal laminotomy was used for additional decompression. Partial resection of the contralateral superior articular process was conducted to preserve the integrity of the facet joint. After complete decompression of the bony structure, the hypertrophic ligamentum flavum was resected to fully decompress the nerve structure.

颅尾椎板切开术用于额外的减压。进行对侧上关节突的部分切除以保持小关节的完整性。在骨结构完全减压后，切除肥厚的黄韧带以完全减压神经结构。

The endpoint of decompression was the outer edge of the bilateral nerve roots.

减压的终点是双侧神经根的外缘。

. Bilateral consistent operation was conducted. Drains were placed bilaterally.

。进行了双边一致的操作。排水管双侧放置。

Fig. 1

图1

A: Determining the position of L3/4/5 pedicle of vertebral arch and target point by body surface fluoroscopy; B: Determining the position of intervertebral space by simultaneous fluoroscopy of two segments; C: standing position of the operator; D: the intraoperative anteroposterior fluoroscopic positioning view..

A：体表透视确定L3/4/5椎弓根和靶点的位置；B：通过两段同时透视确定椎间隙的位置；C：操作员的站立位置；D：术中前后透视定位视图。。

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Dehydration, detumescence, nerve nutrition, and other drugs were used after the operation. On the first day, the patients began to get out of bed under the protection of hard waistline fixation. The drainage was removed within 24 h after the surgery. Within one month after the operation, the patients mainly rested in bed and properly exercised the back muscles.

术后使用脱水、消肿、神经营养等药物。。手术后24小时内清除引流液。术后一个月内，患者主要卧床休息，适当锻炼背部肌肉。

Patients are encouraged to get up and move around early but are not encouraged to participate in physical exercise. Three months after the surgery, the patients were forbidden to do heavy physical activity involving the waist. Postoperative guidance was provided to strengthen the training of back muscle strength, correct inappropriate living habits, and reduce the recurrence rate..

鼓励患者早起走动，但不鼓励患者参加体育锻炼。手术后三个月，患者被禁止进行涉及腰部的剧烈体力活动。术后指导加强背部肌力训练，纠正不适当的生活习惯，降低复发率。。

This study was conducted in accordance with the principles of the Declaration of Helsinki. The ethics committee of our center approved this study. We obtained informed consent from all participants in this study. This study report conforms to the PROCESS standard

这项研究是根据《赫尔辛基宣言》的原则进行的。我们中心的伦理委员会批准了这项研究。我们获得了本研究所有参与者的知情同意。本研究报告符合工艺标准

Observation index

观察指标

The operation time, fluoroscopy times, intraoperative blood loss, postoperative hospital stay, and lumbar Oswestry disability index (ODI) were recorded before the surgery and 1 week and 6 months after the surgery. Modified MacNab was used at 6 months postoperatively

记录术前、术后1周和6个月的手术时间、透视次数、术中出血量、术后住院时间和腰椎Oswestry功能障碍指数（ODI）。术后6个月使用改良MacNab

Statistical analysis

Statistical Analysis IBM SPSS Statistics ver. 22.0 (IBM Co., Armonk, NY, USA) was used for statistical analysis. A paired t-test was used to compare the VAS and ODI scores of low back pain and leg pain before surgery and 1 week and 6 months after surgery. The mean values were expressed as standard deviations, and the Student-t test was used to analyze the differences between the two groups.

统计分析使用IBM SPSS Statistics版本22.0（IBM Co.，Armonk，NY，USA）进行统计分析。采用配对t检验比较术前、术后1周和6个月腰痛和腿痛的VAS和ODI评分。平均值表示为标准偏差，并使用Student-t检验分析两组之间的差异。

A p-value of < 0.05 was considered statistically significant. Intraclass correlation coefficient (ICC) was used to evaluate the intrarepeatability of different observers (interobserver reliability). One independent researcher blinded to the group allocation completed the evaluations..

p值<0.05被认为具有统计学意义。组内相关系数（ICC）用于评估不同观察者的内部重复性（观察者间可靠性）。一位不知道小组分配的独立研究人员完成了评估。。

Results

结果

Results 1: There were 34 males and 31 females, aged 57 to 82 years old, with an average of 66. 88 ± 6.42 years old. The disease course was 6 to 120 months, with an average of 36.13 ± 25.77 months. In total, 64 patients were followed until 1 week and 6 months after the surgery. There were 1 case of L2/3 and L3/4 involvement, 17 cases of L3/4 and L4/5 involvement, 1 case of L3/4 and L5/S1 involvement, and 45 cases of L4/5 and L5/S1 involvement.

结果1：男34例，女31例，年龄57～82岁，平均66岁。88±6.42岁。病程6〜120个月，平均36.13±25.77个月。总共有64名患者接受了随访，直到手术后1周和6个月。L2/3和L3/4受累1例，L3/4和L4/5受累17例，L3/4和L5/S1受累1例，L4/5和L5/S1受累45例。

All patients had neurogenic intermittent claudication with or without radicular pain in the waist and lower extremities. Twenty-two patients were complicated with hypertension, 9 with diabetes mellitus, and 7 with coronary heart disease..

所有患者均患有神经源性间歇性跛行，腰部和下肢有或没有神经根性疼痛。合并高血压22例，糖尿病9例，冠心病7例。。

Results 2: The surgery was successfully completed for 64 patients. The surgical time was 95 ~ 180 min, with an average time of 119.92 ± 14.79 min. The number of fluoroscopy was 2 to 5 (average 3.02 ± 0.9). Intraoperative blood loss ranged from 50 mL to 150 mL, with an average of 73.44 ± 36.70 ml. The mean postoperative hospital stay was 4.

结果2：64例患者手术成功。手术时间95〜180 min，平均119.92±14.79 min。透视次数为2〜5次（平均3.02±0.9）。术中出血量为50〜150 mL，平均73.44±36.70 mL。术后平均住院时间为4。

06 ± 0.96 days (2 to 7 days) (Basement characteristics, Table .

06±0.96天（2至7天）（基底特征，表。

). No complications, such as infection, poor wound healing, and epidural hematoma, occurred during follow-up. One patient had pain and discomfort in the contralateral lower limb after lamina fenestration and was treated with neurotrophic, anti-inflammatory, and analgesic conservative treatment after the surgery.

)。随访期间未发生感染，伤口愈合不良和硬膜外血肿等并发症。一名患者在椎板开窗术后对侧下肢出现疼痛和不适，并在手术后接受了神经营养，抗炎和镇痛保守治疗。

The patient’s symptoms were significantly improved 2 months after the surgery. One patient had a dural tear of nearly 2 mm during the operation. Cauda equina herniation did not occur, which was repaired under the microscope. The skin incision was tightly sutured, and the patient was kept in bed for one week after the surgery.

。一名患者在手术过程中硬膜撕裂近2毫米。马尾疝没有发生，在显微镜下修复。皮肤切口缝合紧密，手术后患者卧床一周。

No special discomfort was found, and the incision healed normally. No antibiotics were prescribed postoperatively..

没有发现特别的不适，切口愈合正常。术后未开具抗生素。。

Table 1 Basement characteristics.

表1地下室特征。

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Results 3: None of the 64 patients experienced the recurrence of their symptoms during the follow-up period. The VAS scores and ODI of the waist and leg at 1 week and 6 months after the surgery were better than those before the surgery (Table

结果3:64例患者在随访期间均未出现症状复发。术后1周和6个月的VAS评分和腰腿ODI均优于术前（表

). Lumbar VAS (

)。腰椎VAS(

< 0.05), leg VAS (

<0.05），腿Vas（

< 0.05), and ODI (

<[UNK]0.05）和ODI(

< 0.05) at 6 months were better than those at 1 week. At 6 months follow-up, 56 patients reported disappearance of intermittent claudication, and 8 patients still had claudication, but their claudication significantly improved compared with their preoperative claudication. Based on the modified MacNab criteria, the results were excellent in 48 cases, good in 14 cases, and fair in 2 cases, and the excellent and good rate was 96.

6个月时<0.05）优于1周时。在6个月的随访中，56例患者报告间歇性跛行消失，8例患者仍有跛行，但与术前跛行相比，跛行明显改善。根据改良MacNab标准，优48例，良14例，可2例，优良率96。

88% (62/64)( Typical Cases, Fig. .

88%（62/64）（典型病例，图）。

Table 2 Comparison of the VAS score and ODI of waist and leg in 64 patients before and after the surgery (X ± s).

表2 64例患者手术前后VAS评分和腰腿ODI的比较（X±s）。

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Fig. 2

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Case 1; Male, 54 years old, lumbar spinal stenosis L3 ~ 5, L3/4 right approach decompression, L4/5 left approach decompression, bilateral simultaneous. A: L3/4 preoperative CT, B: L4/5 preoperative CT, C: preoperative CT reconstruction; D: L3/4 postoperative CT, E: L4/5 postoperative CT, F postoperative CT reconstruction showed that the right L3/4 and the left L4/5 laminae were missing..

案例1；男性，54岁，腰椎管狭窄症L3〜5，L3/4右入路减压，L4/5左入路减压，双侧同时进行。A： L3/4术前CT，B:L4/5术前CT，C：术前CT重建；D： L3/4术后CT，E:L4/5术后CT，F术后CT重建显示右侧L3/4和左侧L4/5椎板缺失。。

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Discussion

讨论

Surgical treatment aims to relieve nerve compression in the spinal canal

手术治疗旨在缓解椎管内的神经压迫

. Conservative treatment is considered the first line of treatment and includes oral analgesics, anti-inflammatory agents, behavioral improvement, and physical therapy

保守治疗被认为是第一线治疗，包括口服止痛药、抗炎药、行为改善和物理治疗

. Additional injectable medications may also be administered to selectively achieve nerve root block or epidural block, although their effectiveness remains inconsistent

。也可以使用其他注射药物来选择性地实现神经根阻滞或硬膜外阻滞，尽管它们的有效性仍然不一致

. Although traditional open surgery can relieve spinal canal compression, the surgical trauma is large, and there may be postoperative discomforts, such as waist and leg pain and discomfort, muscle stiffness, and iatrogenic lumbar instability

尽管传统的开放手术可以缓解椎管压迫，但手术创伤很大，术后可能会出现不适，例如腰腿痛和不适，肌肉僵硬和医源性腰椎不稳

. These discomforts delay the postoperative rehabilitation of elderly patients and increase their mental burden; thus, many patients give up treatment, and their quality-of-life decreases. Related studies

这些不适延迟了老年患者的术后康复并增加了他们的精神负担；因此，许多患者放弃治疗，生活质量下降。相关研究

have reported that for LSS without significant lumbar instability, lumbar spinal canal decompression alone can achieve satisfactory results without the need for more invasive fusion. With the rapid development of spinal endoscopy, UBE has been gradually applied to the treatment of various spinal diseases.

据报道，对于没有明显腰椎不稳的LSS，单独的腰椎管减压可以取得令人满意的结果，而不需要更多的侵入性融合。随着脊柱内窥镜检查的快速发展，UBE已逐渐应用于各种脊柱疾病的治疗。

In this study, lumbar instability and spondylolisthesis of degree II and above were excluded, and ULBD was conducted for 60 patients under dual-channel endoscopy. It belongs to simple spinal canal decompression and conforms to the current concept of minimally invasive surgery. It can minimize intraoperative trauma and blood loss and shorten postoperative recovery without affecting the quality or degree of bone decompression.

在这项研究中，排除了II度及以上的腰椎不稳和腰椎滑脱，并在双通道内镜下对60例患者进行了ULBD。它属于简单的椎管减压，符合目前微创手术的概念。它可以最大程度地减少术中创伤和失血，缩短术后恢复时间，而不影响骨减压的质量或程度。

As early as 2002, Khoo et al.

2002年初，Khoo等人。

. reported the application of MIS-ULBD in the treatment of lumbar spinal stenosis. Spinal surgeons attempt to apply MIS-ULBD to the field of endoscopy. The application of spinal endoscopy in the treatment of LSS with dual-channel UBE-ULBD has become a relatively mature technology. With the help of endoscopic laminectomy rongeur and endoscopic high-speed drill, physicians use total spine endoscopy to effectively and rapidly decompress the central spinal canal, bilateral lateral recesses, and bilateral intervertebral discs using the “overhead decompression” technique.

报道了MIS-ULBD在腰椎管狭窄症治疗中的应用。脊柱外科医生试图将MIS-ULBD应用于内窥镜检查领域。脊柱内镜在双通道UBE-ULBD治疗LSS中的应用已成为一项相对成熟的技术。在内窥镜椎板切除术咬骨钳和内窥镜高速钻的帮助下，医生使用全脊柱内窥镜使用“头顶减压”技术有效快速地减压中央椎管，双侧侧凹和双侧椎间盘。

This strategy can better release the dural sac and bilateral nerve roots.

这种策略可以更好地释放硬脑膜囊和双侧神经根。

. The UBE-ULBD technique minimizes the difficulty of surgery

UBE-ULBD技术将手术难度降至最低

. It has attracted the interest of many spine surgeons and has been reported for multilevel spinal stenosis

。它引起了许多脊柱外科医生的兴趣，并已报道用于多节段椎管狭窄

. However, currently, most physicians still choose two-segment decompression in turn for two-segment stenosis. To shorten the duration of surgery and improve safety, two physicians bilaterally and simultaneously decompressed the two affected segments in this study.

然而，目前大多数医生仍然选择两段减压来治疗两段狭窄。为了缩短手术时间并提高安全性，在本研究中，两名医生双侧同时减压了两个受影响的节段。

In this study, the excellent and good rate of 64 cases of two-segment LSS was 96.88% after 6 months of follow-up. There were no complications, such as infection, poor wound healing, and epidural hematoma. The VAS scores and ODI of the waist and leg at 1 week and 6 months after the surgery were significantly better than those before the surgery (.

本研究中，64例两段LSS患者经6个月随访，优良率为96.88%。没有感染，伤口愈合不良和硬膜外血肿等并发症。术后1周和6个月的VAS评分和腰腿ODI明显优于术前（。

< 0.05). Compared with the sequential multi-segment decompression in previous studies

, simultaneous bilateral decompression significantly shortened the operation time, reduced the operation and exposure time, reduced intraoperative bleeding and radiation exposure, and reduced the length of hospital stay. Two sets of UBE instruments need to be prepared in BS-UBE-ULBD, and the body position and instrument placement need to be planned in advance to avoid interference between the two groups of operators.

，同时双侧减压显着缩短了手术时间，减少了手术和暴露时间，减少了术中出血和辐射暴露，并缩短了住院时间。需要在BS-UBE-ULBD中准备两套UBE仪器，并且需要提前计划身体位置和仪器放置，以避免两组操作员之间的干扰。

This study shows that although the cost of anesthesia and intraoperative fluoroscopy has decreased, the overall surgical cost is still higher than the traditional two-segment UBE-ULBD surgery due to the increased demand for surgical consumables and equipment. However, a mere increase in cost does not indicate a lack of economic benefit from the new technology.

这项研究表明，尽管麻醉和术中透视的成本有所下降，但由于对手术耗材和设备的需求增加，总体手术成本仍高于传统的两段UBE-ULBD手术。然而，仅仅增加成本并不意味着新技术缺乏经济效益。

It is worth noting that although the cost of the operation is slightly higher, the significant shortening of operation time and anesthesia time and the reduction of patient radiation risk bring obvious benefits to patients. .

值得注意的是，虽然手术成本略高，但手术时间和麻醉时间的显着缩短以及患者辐射风险的降低为患者带来了明显的益处。

①

New technology can effectively reduce the time of surgery and anesthesia, improve patient comfort and satisfaction, which may reduce the occurrence of postoperative complications and promote faster recovery.

新技术可以有效减少手术和麻醉时间，提高患者的舒适度和满意度，可以减少术后并发症的发生，促进更快的恢复。

②

Reduce the radiation exposure suffered by patients during surgery, which reflects the hospital’s sense of responsibility for patient health.

减少患者在手术过程中遭受的辐射照射，这反映了医院对患者健康的责任感。

③

Although the total cost of surgery has increased, when combined with multiple factors such as operative time, anesthesia time, risk reduction, and patient safety, this modest cost increase can be regarded as a cost-effective investment. Taking the above factors into consideration, the modest increase in surgical costs is worth the resulting benefits, especially in the context of improved long-term patient outcomes and safety, and this investment is completely justified..

虽然手术总成本增加了，但当结合手术时间，麻醉时间，风险降低和患者安全等多种因素时，这种适度的成本增加可以被视为具有成本效益的投资。考虑到上述因素，手术费用的适度增加值得带来的好处，特别是在改善患者长期预后和安全性的情况下，这种投资是完全合理的。。

Currently, there are some shortcomings, and we will explore and discuss the following shortcomings in future studies:

目前，存在一些不足之处，我们将在未来的研究中探索和讨论以下不足之处：

①

the follow-up time of this study was short, and only two follow-up time points were set, thus long-term efficacy still necessitates further studies;

本研究的随访时间短，仅设定了两个随访时间点，因此长期疗效仍需要进一步研究；

②

there no control group in this study, and objective data were lacking.

本研究没有对照组，缺乏客观数据。

To sum up, BS-UBE-ULBD can effectively treat all clinical symptoms of patients with two-level degenerative lumbar spinal stenosis on the premise of ensuring clinical safety. The BS-UBE-ULBD technology has a good development prospect in the treatment of two-segment or even more segmental degenerative lumbar spinal stenosis..

综上所述，BS-UBE-ULBD可以在确保临床安全的前提下有效治疗两级退行性腰椎管狭窄症患者的所有临床症状。BS-UBE-ULBD技术在治疗两节段甚至更多节段退行性腰椎管狭窄症方面具有良好的发展前景。。

Data availability

The data that support the findings of this study are available from the corresponding author, Si ，Xu upon reasonable request.

支持本研究结果的数据可根据合理要求从通讯作者Si，Xu处获得。

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Authors and Affiliations

作者和隶属关系

Department of Orthopedics, Qilu Hospital of Shandong University (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR, China

山东大学齐鲁医院骨科，山东大学齐鲁医学院，山东青岛266035

Yulin Zhao, Yingjun Guo & Haipeng Si

赵玉林、郭英军、司海鹏

Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, PR, China

山东大学齐鲁医院骨科，山东大学齐鲁医学院，济南，250012

Xin Pan, Hao Li, Xianlei Gao, Haipeng Si & Wanlong Xu

潘欣、李浩、高先磊、斯海鹏、徐万龙

Key Laboratory of Qingdao in Medicine and Engineering, Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, China

Haipeng Si

斯海鹏

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Yulin Zhao

赵玉林

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Yingjun Guo

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Hao Li

郝莉（Hao Li）

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Haipeng Si

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捐款

Zhao mainly wrote the manuscript and collected data, Si, and Xu conceived the methodology and collected data， Guo, Pan, Li, and Gao provided surgical assistance， Si mainly gave guidance, All authors reviewed the manuscript.

赵主要撰写稿件并收集数据，Si和Xu构思了方法并收集了数据，Guo，Pan，Li和Gao提供了手术协助，Si主要提供指导，所有作者都审阅了稿件。

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Haipeng Si

斯海鹏

或

Wanlong Xu

徐万龙

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Zhao, Y., Guo, Y., Pan, X.

赵，Y，郭，Y，潘，X。

et al.

等人。

Bilateral synchronous UBE for unilateral laminotomy and bilateral decompression as a potentially effective minimally Invasive approach for two-level lumbar spinal stenosis.

双侧同步UBE用于单侧椎板切开术和双侧减压，作为治疗两级腰椎管狭窄症的潜在有效微创方法。

Sci Rep

Sci代表

, 2461 (2025). https://doi.org/10.1038/s41598-025-86106-8

, 2461 (2025).https://doi.org/10.1038/s41598-025-86106-8

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26 September 2024

2024年9月26日

Accepted