| Objective To analyze the efficacy and influence factors of unilateral laminectomy for bilateral decompression (ULBD) through unilateral biportal approach endoscopy and unilateral approach endoscopy interlaminar approach for the treatment of lumbar spinal stenosis.Methods A retrospective study was conducted to collect clinical data of 120 patients with lumbar spinal stenosis admitted to Bozhou District People's Hospital, Zunyi City from January 2020 to December 2022. All patients were divided into unilateral biportal approach endoscopy ULBD group (dual channel group, n=51) and unilateral approach endoscopy ULBD group (single channel group, n=69) according to surgical methods. The study evaluated clinical efficacy according to MacNab at 3 months post-surgery, along with surgical indicators such as operation time, intraoperative blood loss and hospital stay, as well as VAS, JOA, and ODI scores before and 3 months after surgery. Patients with lumbar spinal stenosis were divided into effective and ineffective groups according to clinical efficacy after surgery. The baseline data from both groups underwent statistical analysis and comparison. Logistic regression analysis was utilized to examine the risk factors for ineffective postoperative treatment in patients with lumbar spinal stenosis.Results There was no significant difference in the excellent and good rate of the dual channel group(84.31%) and single channel group (81.16%) (P>0.05). The operation time in the dual channel group was shorter than that in the single channel group (P<0.05); there was no significant difference in the intraoperative blood loss between the two groups (P>0.05); the hospital stay in the dual channel group was longer than that in the single channel group (P<0.05). After treatment, the VAS and ODI scores of the two groups were lower than before treatment, while the JOA scores were higher than before treatment (P<0.05); and there were no significant differences in the VAS, JOA, ODI scores between the two groups (P>0.05). The proportion of patients in the ineffective group aged ≥75 years old, with edema type, cystic transformation type, preoperative lumbar instability, and annulus fibrosus rupture in the intramedullary signal, was higher than that in the effective group, and the disease course was longer than that in the effective group (P<0.05). A binary logistic regression model was established, and the results showed that age ≥75 years old, long course of disease, edema type intramedullary signal, cystic transformation, preoperative lumbar instability, and preoperative rupture of the fibrous ring were risk factors for ineffective ULBD treatment in patients with lumbar spinal stenosis (OR>1, P<0.05).Conclusion Both unilateral biportal approach endoscopy and unilateral approach endoscopy ULBD have good therapeutic effects on patients with lumbar spinal stenosis, among which dual channel surgery has the advantage of short surgical time. At the same time, age ≥75 years old, intramedullary signals of edema type, cystic transformation type, preoperative lumbar instability, and fiber ring rupture are risk factors for poor postoperative treatment effect in patients with lumbar spinal stenosis. |
