{"paper_id":"00e460c5-7c3d-4900-b3cf-527e0044db9f","body_text":"Ultrasonic Bone Curette‐Assisted Unilateral approach for bilateral decompression with MISTLIF for Severe lumbar spinal stenosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ultrasonic Bone Curette‐Assisted Unilateral approach for bilateral decompression with MISTLIF for Severe lumbar spinal stenosis Minglei Shao, Yuebing Ren, Ying Nian, Tongxin Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3321439/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose We aim to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MISTLIF) assisted by ultrasonic bone Curette (UBC) in treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MISTLIF in treating severe DLSS. Methods The clinical data of 128 patients with single-segment severe DLSS admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using ultrasonic bone Curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate the low back pain before the operation, one week, and 1, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were used to evaluate the improvement of low back function. At the last follow-up, the Bridwell bone graft fusion standard was used to evaluate the bone graft fusion. Results The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less than those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS and ODI scores than the control group one week after operation (P < 0.05). The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before, six months, one year, and two years after operation (P > 0.05). ZCQ score did not differ significantly between the two groups before the operation, one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up. Conclusions UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can obtain similar clinical efficacy as traditional tools unilateral fenestration bilateral decompression MIS-TLIF and can reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-up. It is a safe and effective surgical method. Ultrasonic bone curette severe lumbar spinal stenosis unilateral fenestration bilateral decompression MIS-TLIF Figures Figure 1 Figure 2 Introduction The degenerative lumbar spinal stenosis (DLSS) incidence is increasing yearly with the gradual arrival of an aging society, and the number of patients with severe DLSS is also increasing [ 1 ]. DLSS is the most common cause of low back and leg pain in middle-aged and elderly people. The DLSS onset is decreasing due to changes in people's lives and work styles, and there is a clear trend of younger age [ 2 ]. Severe DLSS is often accompanied by nerve injury symptoms, such as lower limb muscle strength and significant loss of sensation [ 3 ]. The effect of conservative treatment is poor or even ineffective, and surgical intervention is often needed. Foley et al. [ 4 ] treated lumbar degenerative diseases using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in 2003 and achieved good clinical results. After continuous development, innovation, and improvement of minimally invasive tools, MIS-TLIF surgery technology is maturing, and indications are expanding. Scholars have applied MIS-TILF to treat severe lumbar spinal stenosis and compared it to open transforaminal lumbar interbody fusion or open posterior total laminectomy decompression lumbar interbody fusion. The results exhibit that MIS-TLIF can reduce intraoperative blood loss, shorten hospitalization time, reduce the incidence of adjacent segment degeneration, and achieve excellent interbody fusion and clinical results in the long term [5,6,7]. However, severe DLSS is frequently accompanied by severe osteoporosis hyperplasia and lateral recess stenosis. Traditional surgical methods routinely use osteotome, lamina bite forceps, and other instruments for laminectomy, resulting in an irregular shape and rough edge of the resected lamina, making it easy to break the dural sac when the lamina is removed, thus increasing the bleeding amount, the nerve injury risk, dural sac injury, and complications [7,8]. The emergence of ultrasonic bone Curette technology provides new technical support to reduce the risk of MIS-TLIF surgery. An ultrasonic osteotome, a new osteotomy tool, has recently been applied in the cervical spine, thoracolumbar, and posterior surgery [9,10]. The working frequency of the ultrasonic bone curette is 22.5 ~ 40.0 kHz. When the bone tissue reaches its elastic limit under this mechanical vibration, it vibrates and cuts [11]. Additionally, mechanical vibration is lower than the elastic limit of soft tissue, thus avoiding mechanical damage to soft tissue [12]. Therefore, ultrasonic bone curette, a new type of bone tissue-cutting tool, has the advantages of high bone-cutting efficiency, simple operation, especially high tissue selectivity, and unique advantages in spinal cord and nerve root decompression surgery. However, there are few studies on applying ultrasonic bone curette in treating severe lumbar spinal stenosis using MIS-TLIF. This study retrospectively analyzed the clinical data of patients with single-segment severe lumbar spinal stenosis who underwent unilateral fenestration and bilateral decompression MIS-TLIF with an ultrasonic bone knife between January 2017 and December 2021 and compared them with patients who underwent unilateral fenestration and bilateral decompression MIS-TLIF with traditional tools in the same period. This study aims to explore the therapeutic effect and safety of MIS-TLIF under the ultrasonic bone knife in severe lumbar spinal stenosis. Materials and Methods Study Population Selection A retrospective case-control study was conducted on 128 patients diagnosed with severe lumbar spinal stenosis in our hospital between January 2017 and December 2021 (56 males and 72 females aged 47–82). The average age was 63.2 ± 10.5 years. All patients underwent MIS-TLIF surgery. Among them, 67 patients underwent MIS-TLIF surgery assisted by ultrasonic bone knife (XD860A, Jiangsu Shuimu Tianpeng Technology Co., Ltd, ultrasonic bone knife group, UBC group), whereas 61 patients underwent MIS-TLIF surgery using traditional instruments (control group). Table 1 summarizes the detailed general data of the two patient groups, which are comparable (P > 0.05). All patients in this study met the following inclusion criteria: (1) patients with a significant decrease in muscle strength and sensation of both lower limbs or with cauda equina syndrome; (2) patients diagnosed as severe DLSS (Schizas classification according to MRI images, types C and D were diagnosed as severe DLSS) [13]; (3) clinical symptoms and signs of DLSS; and (4) after regular conservative treatment and improvement of living habits for three months, the symptoms and signs were not relieved or progressively aggravated. Patients who meet the following criteria were excluded: (1) congenital spinal stenosis; (2) severe spinal deformity (scoliosis, kyphosis); (3) combined with spinal tuberculosis, trauma, tumor, and other spinal diseases; and (4) incomplete follow-up data, follow-up time less than 24 months, and lost to follow-up. This study was approved by the Declaration of Helsinki by the Hospital Ethics Committee. Since this work is a retrospective design, the patient's informed consent is not required. All data were collected and analyzed anonymously. Surgical Management The same senior surgeon performed all the surgeries. After administering general anesthesia, the patient was placed in the prone position, the C-arm fluoroscopy was used to locate the surgical segment (and mark the pedicle surface projection position), and the surgical incision was marked with a marker pen. The towel was conventionally disinfected, the skin layer by layer, deep and superficial fascia was cut, blunt separation along the muscle gap established a working channel, and fully exposed the upper and lower articular process and part of the lamina. The specific steps of decompression in the two groups were as follows. Both groups were treated with a minimally invasive pedicle screw system for bilateral percutaneous screw fixation. Ultrasonic bone curette group (UBC, group): The working channel was established on the side with severe lower limb symptoms, and the ultrasonic bone knife was used to removethe inferior articular process and the part of the superior articular process fully exposed the ipsilateral outlet root and the running root(Fig. 1 A).The ultrasonic bone knife was used to remove the side of the lamina to the root of the spinous process, while the lamina rongeur was used to remove the ipsilateral ligamentum flavum. The nerve stripper was used to press the dura mater moderately, whereas the contralateral ligamentum flavum was removed. The ultrasonic bone knife was used to expand the contralateral nerve root canal and lateral recess, and the contralateral nerve root was fully released,treated the intervertebral disc (fully scraped the cartilage endplate), implanted the autologous bone particles in the bone graft funnel (supplemented with allogeneic bone if necessary), and placed the intervertebral fusion device(Fig. 1 B,C). Traditional group (control group): The working channel was established on the side with severe lower limb symptoms. The lower articular process and part of the upper articular process were removed by traditional osteotome, and the ipsilateral outlet root and the running root were fully exposed. The intervertebral disc was treated (the cartilage endplate was fully scraped). The autologous bone particles were implanted in the bone graft funnel (allogeneic bone was supplemented if necessary), and the intervertebral fusion cage was placed. The traditional osteotome or vertebral plate bone rongeur was used to remove one side of the lamina to the root of the spinous process. The vertebral plate bone rongeur was used to remove the ipsilateral ligamentum flavum, while the nerve stripper was used to press the dura mater moderately to remove the contralateral ligamentum flavum. The vertebral plate bone rongeur was used to expand the contralateral nerve root canal and lateral recess to release the contralateral nerve root fully. Postoperative management The postoperative drainage volume and lower limb activity were observed to prevent hematoma formation and nerve compression in the incision. The drainage tube was removed when the drainage volume was less than 50 mL within 24 h. Patients with cerebrospinal fluid leakage were given bedside elevation, and the drainage tube was intermittently clipped after the drainage fluid color was apparent. The drainage tube was removed between the third and fifth postoperative day and sutured and pressurized. After extubation, X-rays, CT, and MRI were used to evaluate decompression and internal fixation. Venous ultrasound of both lower extremities was used to exclude venous thrombosis of the lower extremities, and the thoracolumbar brace was worn to get out of bed. Evaluation Criteria In this study, three independent authors collected clinical data, including clinical and imaging evaluation results before surgery, one week, 1, 3, 6, 12, and 24 months after surgery, and at the last follow-up. All patients were followed up for more than two years. Clinical evaluation and imaging evaluation index: (1) Visual analog scale (VAS): The pain VAS scores of the patients were measured by the nurses and two doctors in the same group before the operation, one week after the operation, and at each follow-up time point. The average value was calculated and recorded; (2) The Oswestry Disability Index (ODI) and the Zurich Claudication Questionnaire (ZCQ) were calculated by three doctors in the same group before the operation, one week after the operation, and at each follow-up time point. The average value was calculated and recorded; (3) The hospitalization time, operation time, intraoperative blood loss, and perioperative complications were recorded, including incision complications such as infection, incision nonunion, hematoma formation, internal fixation complications such as pedicle screw misplacement, endplate fracture, cage subsidence and displacement, pedicle screw loosening and fracture, dural and nerve root complications such as an intraoperative tear of the dural sac, injury of a nerve root or cauda equina nerve, and contralateral nerve symptoms; (4) Fusion rate: At the last follow-up, the lumbar spine was collected, and the lumbar interbody fusion was graded by Bridwell method [14]. I and II were fusions. If DR examination could not be determined, lumbar CT examination could be further improved. Statistical Analysis All statistical analyses were performed using SPSS version 23.0 (SPSS Inc, Chicago, IL, USA). The data were expressed as mean ± standard deviation (SD). Repeated measurement multi-factor analysis of variance (MANOVA) was used to analyze the treatment results. Additionally, the independent two-sample t-test was used to determine whether there was a significant difference between the two groups, and the chi-square test (small sample Fisher exact test) was used to analyze the categorical data in the two groups. All analyses were statistically significant at P < 0.05. Results Table 1 summarizes the demographic characteristics and baseline characteristics of the two groups. Baseline demographic data analysis revealed no significant difference between the two groups (P > 0.05). The two groups were primarily Schizas grade C (severe stenosis, UBC 71.6%, control 65.6%), and the rest of the patients had severe stenosis (Schizas grade D). The course, combined disease, and follow-up time did not differ significantly between the two groups. Table 1 Patients’ demographic data Variables UBC(n = 67) Control(n = 61) p-value Age(years) 63.4 ± 10.7 62.9 ± 10.2 0.815 Sex(%) Female 49(73.1%) 43(70.5%) 0.844 male 18(26.9%) 18(29.5.2%) BMI(kg/m 2 ) 26.7 ± 3.4 25.7 ± 3.3 0.107 Smoker,n(%) 18(26.9%) 20(32.8%) 0.562 Operative level, n(%) L3−4 8(11.9%) 10(16.4%) 0.769 L4−5 28(41.8%) 24(39.3%) L5-S1 31(46.3%) 27(44.3%) Schizas classification,n(%) C 48(71.6%) 40(65.6%) 0.567 D 19(28.4%) 21(34.4%) Duration of disease (days) 36.6 ± 8.5 36.4 ± 8.3 0.889 Comorbidity Hypertension 12(17.9%) 16(26.2%) 0.289 Cardiopathy 16(23.9%) 19(31.1%) Lung disease 12(17.9%) 16(26.2%) Follow-up (months) 18.7 ± 4.1 19.1 ± 3.7 0.593 BMI, body mass index; Schizas classification on MRI. Grade A, CSF is clearly visible inside the dural sac. Grade B, rootlets occupy the entire dural sac but can still be individualized. Grade C, rootlets cannot be individualized with posterior epidural fat and invisible CSF. Grade D, rootlets cannot be individualized without posterior epidural fat. The UBC group had shorter operation time (146.9 ± 13.9 vs.152.1 ± 13.7 min) and less estimated blood loss (116.9 ± 16.5 vs. 41.5 ± 22.2 mL) than the control group, and the difference between the two groups was statistically significant (P < 0.05, Table 2 ). The length of hospital stay between the two groups did not differ significantly (P > 0.05). The perioperative complications of dural sac tear (n = 2) in the UBC group and dural sac tear (n = 3) and incision infection (n = 1, n = 2) in the control group did not differ significantly (P > 0.05). These complications subsided within one month after the operation. CSA did not differ significantly between the two groups after operation (P > 0.05), confirming that the decompression effect of the two groups after operation (UBC preoperative 0.82 ± 0.09 vs. postoperative 1.53 ± 0.05 cm 2 , control preoperative 0.81 ± 0.08 vs. postoperative 1.54 ± 0.04 cm 2 , P < 0.05, Table 2 ) was equivalent. Table 2 Perioperative characteristics by type of procedure Variables UBC(n = 67) Control(n = 61) p-value Operative time, min 146.9 ± 13.9 152.1 ± 13.7 0.035* EBL,ml 116.9 ± 16.5 123.8 ± 15.8 0.017* Length of hospital stay (days) 5.6 ± 1.7 5.8 ± 1.5 0.551 Perioperative complications, n (%) 3 5 0.605 Dural sac tearing 2(3%) 3(4.9%) Incision infection 1 2(3.4%) dural sac CSA, cm 2 Preop 0.82 ± 0.09 0.81 ± 0.08 0.700 1 year postop 1.53 ± 0.05 1.54 ± 0.04 0.447 Improvement percentage of dural sac CSA(%) 87.7 ± 20.3 89.9 ± 20.8 0.546 EBL, estimated blood loss; CSA, cross-sectional area * indicates p < 0.05. The VAS, ODI, and ZCQ scores of the two groups were significantly improved at each follow-up time point than before the operation (P < 0.05). One week after the operation, the VAS (2.82 ± 0.76) and ODI (35.81 ± 2.55) scores were significantly better in the UBC group than in the control group (VAS: 3.16 ± 0.90, ODI: 39.91 ± 2.03, P < 0.05, Table 3 ). VAS and ODI scores did not differ significantly between the two groups at six months, one year, and two years after operation (P > 0.05). ZCQ scores did not differ significantly between the two groups at each follow-up time point (P > 0.05). Table 3 Comparison for postoperative VAS,ODI and ZCQ score Scoring System UBC(n = 67) Control(n = 61) p-value VAS Preop (mean score) 6.95 ± 1.51 7.00 ± 1.53 0.868 Postop (1 wk) 2.82 ± 0.76 3.16 ± 0.90 0.021* Follow-up at 6 mos 2.36 ± 0.83 2.34 ± 0.73 0.920 Follow-up at 1 yrs 1.94 ± 0.69 2.11 ± 0.61 0.134 Follow-up at 2 yrs 1.82 ± 0.60 1.93 ± 0.54 0.266 p value (pre vs post) 0.000** 0.000** ODI Preop (mean score) 62.13 ± 3.51 61.13 ± 2.82 0.079 Postop (1 wk) 35.81 ± 2.55 39.91 ± 2.03 0.008** Follow-up at 6 mos 16.58 ± 2.40 16.77 ± 2.41 0.659 Follow-up at 1 yrs 12.81 ± 1.36 12.97 ± 1.48 0.523 Follow-up at 2 yrs 12.10 ± 0.92 12.23 ± 0.88 0.236 p value (pre vs post) 0.000** 0.000** ZCQ Preop (mean score) 66.85 ± 2.57 66.03 ± 2.31 0.062 Postop (1 wk) 38.67 ± 3.67 39.85 ± 3.90 0.080 Follow-up at 6 mos 22.18 ± 3.10 21.59 ± 2.72 0.258 Follow-up at 1 yrs 19.72 ± 2.39 20.20 ± 1.97 0.219 Follow-up at 2 yrs 18.71 ± 1.74 19.10 ± 1.77 0.220 p value (pre vs post) 0.000** 0.000** VAS,Visual Analogue Scale; ODI,Oswestry Disability Index; ZCQ,Zurich Claudication Questionnaire; * indicates p < 0.05,** indicates p < 0.01. Discussion The ultrasonic bone curette converts the electrical signal into mechanical vibration via a piezoelectric converter, causing the knife head to vibrate at a high frequency and low amplitude. Due to the difference in tissue density and elasticity, most of the energy generated by ultrasonic bone curette is absorbed by hard bone tissue. It plays a role in bone cutting via mechanical fragmentation and cavitation effects. Soft tissues, such as nerve roots, dura mater, and spinal cord, are in elastic contact with the ultrasonic scalpel at the same frequency and amplitude, reducing the risk of direct damage to soft tissues [9,15]. Studies have demonstrated that ultrasonic bone knives can effectively avoid mechanical and thermal damage to nerve roots compared to high-speed grinding drills or traditional tools, such as vertebral plate bone rongeurs, bone knives, and pointed mouth bone rongeurs [16,17]. Morimoto et al. [18] discovered that ultrasonic osteotome for lumbar lamina fenestration and intervertebral foramen decompression in treating lumbar spinal stenosis has less surgical trauma and higher surgical safety than traditional osteotome and lamina rongeur. This study discovered that in clinical practice, an ultrasonic bone knife outperforms a high-speed grinding drill and a gun-shaped bone rongeur for spinal canal decompression. Severe DLSS mostly has ossified hard ligamentum flavum or intervertebral disc and severe bone hyperplasia. The pressure-causing substance is closely adhered to the dural sac and nerve root, with no buffer space [1,19]. If a high-speed grinding drill and gun-shaped bone rongeur are used for decompression, a brain cotton sheet and nerve stripper must be used to depress and protect the dura mater. The above operation of traditional tools in narrow spaces increases the difficulty and time of operation and increases the risk of nerve and dura mater injury. When the high-speed grinding drill is used, there is a situation of winding soft tissue, and the narrow space is unclear, which can easily cause the risk of dural and nerve root injury. Ultrasonic bone knife decompression requires only forcing the rake head to the back and grinding out the bone structure, reducing the risk of dural compression and nerve root injury. This study revealed that the postoperative dural sac CSA of the two groups was significantly higher than before surgery, with no significant difference in postoperative CSA between the two groups. Nerve root injury has no complications in the two groups. There were two cases of dural injury and three cases of cerebrospinal fluid leakage in the UBC and the control groups, respectively. The incidence between the two groups did not differ significantly. Therefore, we believe the ultrasonic bone knife is a safe and feasible tool in laminectomy, lateral recess decompression, and decompression surgery. Previous reports have achieved good clinical results using gun-shaped bone rongeur, high-speed grinding drill, or endoscopic unilateral fenestration to sneak out the hypertrophic ligamentum flavum, expand the lateral recess and nerve root canal, and expose and release the contralateral nerve root [20–21]. In this study, patients in the UBC group were treated with decompression of the contralateral spinal canal and nerve root canal using direct vision of an ultrasonic bone knife. The postoperative low back pain, intermittent claudication, and low back dysfunction were significantly relieved compared to those before the operation. VAS, ODI, and ZCQ scores did not differ significantly between the two groups during the mid-term follow-up (P > 0.05). Our study presented no significant difference in intervertebral fusion rate between the two groups at the last follow-up (P > 0.05). Therefore, we believe that MIS-TLIF with unilateral fenestration and bilateral decompression by ultrasonic bone knife can achieve similar mid-term clinical efficacy as traditional tool laminectomy decompression. Studies have demonstrated that the high-frequency vibration of the contact surface between the blade and the bone tissue can produce thermal and cavitation effects during the removal of the lamina by the ultrasonic osteotome, thereby significantly reducing the bleeding of the bone tissue section [22]. The instantaneous high temperature generated at the interface between the ultrasonic bone knife and bone promotes the contraction of local microvessels and increases the thrombin activity, playing an important role in local hemostasis [22,23]. The cavitation effect of the ultrasonic bone knife is to strengthen the local coagulation function by emulsifying and breaking the surrounding soft tissue and promoting the coagulation and degeneration of hemoglobin [15,22,23]. Bone wax is frequently used to stop bleeding on the bone surface when traditional bone knives and gun-shaped bite forceps are used to remove the lamina. This method of hemostasis is rough and often incomplete, which is an important factor in increasing the amount of bleeding during the operation. Studies have revealed that using an ultrasonic bone knife for cervical laminectomy, thoracic laminectomy, and osteotomy in the scoliosis correction steps to treat the corresponding diseases resulted in less intraoperative blood loss than traditional laminectomy tools [15,22,23,24]. In this study, the ultrasonic bone knife group had significantly less intraoperative blood loss and postoperative drainage volume than the traditional group, consistent with previous reports. Therefore, we believe an ultrasonic bone knife is important in reducing bleeding during lumbar laminectomy and lateral recess decompression. DLSS is more common in middle-aged and elderly patients. It is easy to cause clinical symptoms, such as low back pain, intermittent claudication, and radiation pain in both lower limbs, seriously affecting the patient’s quality of life. MIS-TLIF is the most widely used and mature minimally invasive decompression and fusion technique. Unilateral fenestration and bilateral decompression mis-TLIF have been used in the surgical treatment of DLSS and have achieved good clinical results [ 25 , 26 ]. However, severe DLSS mostly has ossified hard ligamentum flavum or intervertebral disc and severe bone hyperplasia. The dural sac and nerve root lack movement space and the pressure substance is closely adhered to the dural sac and nerve root, often without any buffer space. Conventional decompression tools can easily damage the dural sac and nerve root. The bone knife, lamina bite forceps for narrow segment laminectomy, nerve root canal enlargement, unilateral approach bilateral nerve root decompression, or bilateral establishment of channels for bilateral decompression are used in conventional MIS-TLIF surgery for severe lumbar spinal stenosis [ 25 , 26 , 27 ]. This type of surgery has large trauma, more bleeding, and longer operation time, which can easily increase the incidence of perioperative complications [ 26 , 27 ]. The operation time and bone-cutting efficiency of ultrasonic osteotome were significantly better than those of traditional tools. In this study, the operation time of the ultrasonic osteotome group was significantly shorter than that of the traditional group, consistent with previous research reports [22,23]. To solve the above problems, we adopted the ultrasonic bone knife-assisted unilateral approach bilateral decompression MIS-TLIF surgery to treat lumbar spinal stenosis, reducing intraoperative bleeding, shortening the operation time, and obtaining good clinical efficacy. In this study, the VAS and ODI scores of low back pain were better in the ultrasonic bone knife group than in the traditional group one week after the operation, possibly due to the stimulation and concussion of peripheral nerves by conventional tools (bone knife and vertebral plate bone biting forceps) in the traditional group. VAS, ODI, and ZCQ scores did not differ significantly between the two groups during the mid-term follow-up (P > 0.05). Therefore, we believe that MIS-TLIF assisted by ultrasonic bone knife has less trauma, faster recovery, and shorter operation time than the traditional tool group while achieving the same mid-term clinical efficacy. The long-term clinical efficacy still needs further follow-up. This is a retrospective clinical study. The evidence level is low, and the total number of cases is small. Prospective clinical studies of larger cases are needed. Conclusion Ultrasonic osteotome unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve similar mid-term clinical efficacy as traditional tool laminectomy decompression MIS-TLIF. It can reduce the operation time, intraoperative blood loss, and postoperative drainage. Short-term follow-up can reduce the degree of low back pain. It is a safe and effective surgical method. However, this is a retrospective clinical study. The evidence level is low, the sample size is small, and a prospective clinical study of larger cases is needed to prove further. Abbreviations DLSS Degenerative Lumbar Spinal Stenosis MIS-TLIF Minimally Invasive Transforaminal Lumbar Interbody Fusion UBC Ultrasonic Bone Curette VAS Visual Analogue Scale ODI Oswestry disability index ZCQ Zurich claudication score MRI Magnetic resonance imaging Declarations Acknowledgements Not applicable. Author contributions Minglei Shao and Tongxin Sun conceptualized and designed the study. Yuebing Ren performed an experiment and helped in the acquisition of data. Ying Nian and Minglei Shao were responsible for analysis and interpretation of data. Minglei Shao and Yuebing Ren helped to draft the manuscript. Yuebing Ren helped to revise the manuscript critically for important intellectual content. All authors read and approved the final manuscript. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author upon any reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of Dongying People 's Hospital ( DYYX-2023-171 ). All participants provided informed written consent. All methods are in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688-1699. doi: 10.1001/jama.2022.5921. Bumann H, Nüesch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Schären S, Mündermann A, Netzer C. 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Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976).2010;35(21):1919-24.doi: 10.1097/BRS.0b013e3181d359bd. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976). 1995;20(12):1410-8. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J. 2013;22(12):2845-9. doi: 10.1007/s00586-013-2780-y. Hazer DB, Yaşar B, Rosberg HE, Akbaş A. Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients. Biomed Res Int. 2016;2016:8428530. doi: 10.1155/2016/8428530. Onen MR, Yuvruk E, Akay S, et al The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg. 2015;84(6):1962–1967. doi: 10.1016/j.wneu.2015.08.043. Morimoto D, Isu T, Kim K, et al Microsurgical medial fenestration with an ultrasonic bone curette for lumbar foraminal stenosis. J Nippon Med Sch. 2012;79(5):327–334. doi: 10.1272/jnms.79.327. Bumann H, Nüesch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Schären S, Mündermann A, Netzer C. Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking. Spine J. 2020;20(1):112-120. doi: 10.1016/j.spine e.2019.08.016. Tan B, Yang QY, Fan B, Xiong C. Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: A comparative study with decompression via open discectomy. Front Neurol. 2023;14:1132698. doi: 10.3389/fneur.2023.1132698. Sanderson PL, Getty CJ Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine (Phila Pa 1976) 1996;21(11):1352–1356. doi: 10.1097/00007632-199606010-00015. Liu J, Kong Q, Feng P, Zhang B, Ma J, Hu Y. Analysis of the curative effect of cervical spondylotic radiculopathy with osseous foraminal stenosis using ultrasonic osteotome in anterior cervical surgery. BMC Musculoskelet Disord. 2023;24(1):81. doi: 10.1186/s12891-022-06083-1. Kim K, Isu T, Matsumoto R, Isobe M, Kogure K. Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery.2006;59(4 Suppl 2): ONS390-3; discussion ONS393. doi: 10.1227/01.NEU.0000222655.69368.19. Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. Kang MS, You KH, Choi JY, Heo DH, Chung HJ, Park HJ. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J. 2021;21(12):2066-2077. doi: 10.1016/j.spinee.2021.06.013. Gao QY, Wei FL, Li T, Zhu KL, Du MR, Heng W, Yang F, Gao HR, Qian JX, Zhou CP. Oblique Lateral Interbody Fusion vs. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis: A Retrospective Cohort Study. Front Med (Lausanne). 2022;9:829426.doi: 10.3389/fmed.2022.829426. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3321439\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":230927221,\"identity\":\"f2e994db-a163-465c-ab59-f56f2ad5e318\",\"order_by\":0,\"name\":\"Minglei Shao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dongying People's Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Minglei\",\"middleName\":\"\",\"lastName\":\"Shao\",\"suffix\":\"\"},{\"id\":230927222,\"identity\":\"4ffa213d-5d5e-41f9-83f9-33e8246317cf\",\"order_by\":1,\"name\":\"Yuebing Ren\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dongying People's Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yuebing\",\"middleName\":\"\",\"lastName\":\"Ren\",\"suffix\":\"\"},{\"id\":230927223,\"identity\":\"6c3f84cc-2cee-4b9f-a8ad-a622b61a1bd6\",\"order_by\":2,\"name\":\"Ying Nian\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dongying People's Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ying\",\"middleName\":\"\",\"lastName\":\"Nian\",\"suffix\":\"\"},{\"id\":230927224,\"identity\":\"7237f35a-de32-49e3-8966-60ae009a6644\",\"order_by\":3,\"name\":\"Tongxin Sun\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYFAC5gaGBAMbO34GxgZitQBVJhSkJUs2kKSF4cNhxg0HiNUgP+1g44MHBszMxucPtz34wWAnp0vIMoPbic0GCQZsfGY3EtsNexiSjc0IWWcgndgmkWDAw2x2g7FNgofhQOI2QlrkZye2/0gwkGDc3H+wTfIPMVoYbie2AQPZgHEDQ2KbNFG2gPwCdFhCssQNoBYZAyL8Ij87+eDHH3/+2/H3H38m+abCTo6gFnRLSVM+CkbBKBgFowAHAAAZlEIJS/PnbQAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Dongying People's Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Tongxin\",\"middleName\":\"\",\"lastName\":\"Sun\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2023-09-03 10:29:13\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3321439/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3321439/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":42829708,\"identity\":\"d4bfc02c-8c67-4bfa-9651-7bdec93842f4\",\"added_by\":\"auto\",\"created_at\":\"2023-09-08 13:47:23\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2349588,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe operation process of Ultrasonic bone curette MIS-TLIF technique: A the ultrasonic bone knife was used to removethe inferior articular process and the part of the superior articular process fully exposed the ipsilateral outlet root and the running root; B the ultrasonic bone knife was used to remove the side of the lamina to the root of the spinous process, while the lamina rongeur was used to remove the ipsilateral ligamentum flavum; C the nerve stripper was used to press the dura mater moderately, whereas the contralateral ligamentum flavum was removed. The ultrasonic bone knife was used to expand the contralateral nerve root canal and lateral recess, and the contralateral nerve root was fully released.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3321439/v1/9d5e8f48b5ef6591c4dbfb9a.png\"},{\"id\":42830533,\"identity\":\"a1650a02-2124-447c-be1e-aca7b385a89f\",\"added_by\":\"auto\",\"created_at\":\"2023-09-08 13:55:23\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3065570,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eIn group Ultrasonic bone curette, a 74 - year- old woman suffered from low back pain accompanied with intermittent claudication more than 3 years. Preoperative Xray ( a,b), MRI (d), and CT (c) examinations showed severe DLSS(Schizas Grade D) at L4/L5 level . The patient received Mis-TLIF assisted by ultrasonic bone knife and symptoms significantly relieved after the surgery. Postoperative X ray (e,f), Post-operative CT/MRI indicated completed decompression was achieved at L4/L5 (g,h).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"figure2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3321439/v1/fb36c8921c2344c1b1bd2b53.png\"},{\"id\":48181734,\"identity\":\"70899129-d54f-4574-95e5-713f40c11af4\",\"added_by\":\"auto\",\"created_at\":\"2023-12-14 07:53:05\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2652877,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3321439/v1/01bfa7c5-472f-4094-892d-5c45af5640ed.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Ultrasonic Bone Curette‐Assisted Unilateral approach for bilateral decompression with MISTLIF for Severe lumbar spinal stenosis\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe degenerative lumbar spinal stenosis (DLSS) incidence is increasing yearly with the gradual arrival of an aging society, and the number of patients with severe DLSS is also increasing [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. DLSS is the most common cause of low back and leg pain in middle-aged and elderly people. The DLSS onset is decreasing due to changes in people's lives and work styles, and there is a clear trend of younger age [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Severe DLSS is often accompanied by nerve injury symptoms, such as lower limb muscle strength and significant loss of sensation [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The effect of conservative treatment is poor or even ineffective, and surgical intervention is often needed.\\u003c/p\\u003e \\u003cp\\u003eFoley et al. [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e] treated lumbar degenerative diseases using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in 2003 and achieved good clinical results. After continuous development, innovation, and improvement of minimally invasive tools, MIS-TLIF surgery technology is maturing, and indications are expanding. Scholars have applied MIS-TILF to treat severe lumbar spinal stenosis and compared it to open transforaminal lumbar interbody fusion or open posterior total laminectomy decompression lumbar interbody fusion. The results exhibit that MIS-TLIF can reduce intraoperative blood loss, shorten hospitalization time, reduce the incidence of adjacent segment degeneration, and achieve excellent interbody fusion and clinical results in the long term [5,6,7]. However, severe DLSS is frequently accompanied by severe osteoporosis hyperplasia and lateral recess stenosis. Traditional surgical methods routinely use osteotome, lamina bite forceps, and other instruments for laminectomy, resulting in an irregular shape and rough edge of the resected lamina, making it easy to break the dural sac when the lamina is removed, thus increasing the bleeding amount, the nerve injury risk, dural sac injury, and complications [7,8]. The emergence of ultrasonic bone Curette technology provides new technical support to reduce the risk of MIS-TLIF surgery.\\u003c/p\\u003e \\u003cp\\u003eAn ultrasonic osteotome, a new osteotomy tool, has recently been applied in the cervical spine, thoracolumbar, and posterior surgery [9,10]. The working frequency of the ultrasonic bone curette is 22.5\\u0026thinsp;~\\u0026thinsp;40.0 kHz. When the bone tissue reaches its elastic limit under this mechanical vibration, it vibrates and cuts [11]. Additionally, mechanical vibration is lower than the elastic limit of soft tissue, thus avoiding mechanical damage to soft tissue [12]. Therefore, ultrasonic bone curette, a new type of bone tissue-cutting tool, has the advantages of high bone-cutting efficiency, simple operation, especially high tissue selectivity, and unique advantages in spinal cord and nerve root decompression surgery. However, there are few studies on applying ultrasonic bone curette in treating severe lumbar spinal stenosis using MIS-TLIF. This study retrospectively analyzed the clinical data of patients with single-segment severe lumbar spinal stenosis who underwent unilateral fenestration and bilateral decompression MIS-TLIF with an ultrasonic bone knife between January 2017 and December 2021 and compared them with patients who underwent unilateral fenestration and bilateral decompression MIS-TLIF with traditional tools in the same period. This study aims to explore the therapeutic effect and safety of MIS-TLIF under the ultrasonic bone knife in severe lumbar spinal stenosis.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eStudy Population Selection\\u003c/h2\\u003e\\n\\u003cp\\u003eA retrospective case-control study was conducted on 128 patients diagnosed with severe lumbar spinal stenosis in our hospital between January 2017 and December 2021 (56 males and 72 females aged 47\\u0026ndash;82). The average age was 63.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.5 years.\\u003c/p\\u003e\\n\\u003cp\\u003eAll patients underwent MIS-TLIF surgery. Among them, 67 patients underwent MIS-TLIF surgery assisted by ultrasonic bone knife (XD860A, Jiangsu Shuimu Tianpeng Technology Co., Ltd, ultrasonic bone knife group, UBC group), whereas 61 patients underwent MIS-TLIF surgery using traditional instruments (control group).\\u003c/p\\u003e\\n\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e summarizes the detailed general data of the two patient groups, which are comparable (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). All patients in this study met the following inclusion criteria: (1) patients with a significant decrease in muscle strength and sensation of both lower limbs or with cauda equina syndrome; (2) patients diagnosed as severe DLSS (Schizas classification according to MRI images, types C and D were diagnosed as severe DLSS) [13]; (3) clinical symptoms and signs of DLSS; and (4) after regular conservative treatment and improvement of living habits for three months, the symptoms and signs were not relieved or progressively aggravated.\\u003c/p\\u003e\\n\\u003cp\\u003ePatients who meet the following criteria were excluded: (1) congenital spinal stenosis; (2) severe spinal deformity (scoliosis, kyphosis); (3) combined with spinal tuberculosis, trauma, tumor, and other spinal diseases; and (4) incomplete follow-up data, follow-up time less than 24 months, and lost to follow-up. This study was approved by the Declaration of Helsinki by the Hospital Ethics Committee. Since this work is a retrospective design, the patient's informed consent is not required. All data were collected and analyzed anonymously.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eSurgical Management\\u003c/h2\\u003e\\n\\u003cp\\u003eThe same senior surgeon performed all the surgeries. After administering general anesthesia, the patient was placed in the prone position, the C-arm fluoroscopy was used to locate the surgical segment (and mark the pedicle surface projection position), and the surgical incision was marked with a marker pen. The towel was conventionally disinfected, the skin layer by layer, deep and superficial fascia was cut, blunt separation along the muscle gap established a working channel, and fully exposed the upper and lower articular process and part of the lamina. The specific steps of decompression in the two groups were as follows. Both groups were treated with a minimally invasive pedicle screw system for bilateral percutaneous screw fixation.\\u003c/p\\u003e\\n\\u003cp\\u003eUltrasonic bone curette group (UBC, group): The working channel was established on the side with severe lower limb symptoms, and the ultrasonic bone knife was used to removethe inferior articular process and the part of the superior articular process fully exposed the ipsilateral outlet root and the running root(Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eA).The ultrasonic bone knife was used to remove the side of the lamina to the root of the spinous process, while the lamina rongeur was used to remove the ipsilateral ligamentum flavum. The nerve stripper was used to press the dura mater moderately, whereas the contralateral ligamentum flavum was removed. The ultrasonic bone knife was used to expand the contralateral nerve root canal and lateral recess, and the contralateral nerve root was fully released,treated the intervertebral disc (fully scraped the cartilage endplate), implanted the autologous bone particles in the bone graft funnel (supplemented with allogeneic bone if necessary), and placed the intervertebral fusion device(Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eB,C).\\u003c/p\\u003e\\n\\u003cp\\u003eTraditional group (control group): The working channel was established on the side with severe lower limb symptoms. The lower articular process and part of the upper articular process were removed by traditional osteotome, and the ipsilateral outlet root and the running root were fully exposed. The intervertebral disc was treated (the cartilage endplate was fully scraped). The autologous bone particles were implanted in the bone graft funnel (allogeneic bone was supplemented if necessary), and the intervertebral fusion cage was placed. The traditional osteotome or vertebral plate bone rongeur was used to remove one side of the lamina to the root of the spinous process. The vertebral plate bone rongeur was used to remove the ipsilateral ligamentum flavum, while the nerve stripper was used to press the dura mater moderately to remove the contralateral ligamentum flavum. The vertebral plate bone rongeur was used to expand the contralateral nerve root canal and lateral recess to release the contralateral nerve root fully.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003ePostoperative management\\u003c/h2\\u003e\\n\\u003cp\\u003eThe postoperative drainage volume and lower limb activity were observed to prevent hematoma formation and nerve compression in the incision. The drainage tube was removed when the drainage volume was less than 50 mL within 24 h. Patients with cerebrospinal fluid leakage were given bedside elevation, and the drainage tube was intermittently clipped after the drainage fluid color was apparent. The drainage tube was removed between the third and fifth postoperative day and sutured and pressurized. After extubation, X-rays, CT, and MRI were used to evaluate decompression and internal fixation. Venous ultrasound of both lower extremities was used to exclude venous thrombosis of the lower extremities, and the thoracolumbar brace was worn to get out of bed.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eEvaluation Criteria\\u003c/h2\\u003e\\n\\u003cp\\u003eIn this study, three independent authors collected clinical data, including clinical and imaging evaluation results before surgery, one week, 1, 3, 6, 12, and 24 months after surgery, and at the last follow-up. All patients were followed up for more than two years.\\u003c/p\\u003e\\n\\u003cp\\u003eClinical evaluation and imaging evaluation index: (1) Visual analog scale (VAS): The pain VAS scores of the patients were measured by the nurses and two doctors in the same group before the operation, one week after the operation, and at each follow-up time point. The average value was calculated and recorded; (2) The Oswestry Disability Index (ODI) and the Zurich Claudication Questionnaire (ZCQ) were calculated by three doctors in the same group before the operation, one week after the operation, and at each follow-up time point. The average value was calculated and recorded; (3) The hospitalization time, operation time, intraoperative blood loss, and perioperative complications were recorded, including incision complications such as infection, incision nonunion, hematoma formation, internal fixation complications such as pedicle screw misplacement, endplate fracture, cage subsidence and displacement, pedicle screw loosening and fracture, dural and nerve root complications such as an intraoperative tear of the dural sac, injury of a nerve root or cauda equina nerve, and contralateral nerve symptoms; (4) Fusion rate: At the last follow-up, the lumbar spine was collected, and the lumbar interbody fusion was graded by Bridwell method [14]. I and II were fusions. If DR examination could not be determined, lumbar CT examination could be further improved.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\n\\u003cp\\u003eAll statistical analyses were performed using SPSS version 23.0 (SPSS Inc, Chicago, IL, USA). The data were expressed as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD). Repeated measurement multi-factor analysis of variance (MANOVA) was used to analyze the treatment results. Additionally, the independent two-sample t-test was used to determine whether there was a significant difference between the two groups, and the chi-square test (small sample Fisher exact test) was used to analyze the categorical data in the two groups. All analyses were statistically significant at P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e summarizes the demographic characteristics and baseline characteristics of the two groups. Baseline demographic data analysis revealed no significant difference between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The two groups were primarily Schizas grade C (severe stenosis, UBC 71.6%, control 65.6%), and the rest of the patients had severe stenosis (Schizas grade D). The course, combined disease, and follow-up time did not differ significantly between the two groups.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption\\u003e\\n\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n\\u003cp\\u003ePatients\\u0026rsquo; demographic data\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003c/caption\\u003e\\n\\u003cthead\\u003e\\n\\u003ctr\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eVariables\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eUBC(n\\u0026thinsp;=\\u0026thinsp;67)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eControl(n\\u0026thinsp;=\\u0026thinsp;61)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep-value\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/thead\\u003e\\n\\u003ctbody\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eAge(years)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e63.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.7\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e62.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.2\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.815\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eSex(%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFemale\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e49(73.1%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e43(70.5%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.844\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003emale\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e18(26.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e18(29.5.2%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eBMI(kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e26.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.4\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e25.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.3\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.107\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eSmoker,n(%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e18(26.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e20(32.8%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.562\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eOperative level, n(%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eL3\\u0026minus;4\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e8(11.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e10(16.4%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.769\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eL4\\u0026minus;5\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e28(41.8%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e24(39.3%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eL5-S1\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e31(46.3%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e27(44.3%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eSchizas classification,n(%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eC\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e48(71.6%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e40(65.6%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.567\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eD\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e19(28.4%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e21(34.4%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eDuration of disease (days)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e36.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.5\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e36.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.3\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.889\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eComorbidity\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eHypertension\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12(17.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e16(26.2%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.289\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eCardiopathy\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e16(23.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e19(31.1%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eLung disease\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12(17.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e16(26.2%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up (months)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e18.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.1\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e19.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.7\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.593\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eBMI, body mass index;\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eSchizas classification on MRI.\\u003c/p\\u003e\\n\\u003cp\\u003eGrade A, CSF is clearly visible inside the dural sac.\\u003c/p\\u003e\\n\\u003cp\\u003eGrade B, rootlets occupy the entire dural sac but can still be individualized.\\u003c/p\\u003e\\n\\u003cp\\u003eGrade C, rootlets cannot be individualized with posterior epidural fat and invisible CSF.\\u003c/p\\u003e\\n\\u003cp\\u003eGrade D, rootlets cannot be individualized without posterior epidural fat.\\u003c/p\\u003e\\n\\u003cp\\u003eThe UBC group had shorter operation time (146.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.9 vs.152.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.7 min) and less estimated blood loss (116.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.5 vs. 41.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;22.2 mL) than the control group, and the difference between the two groups was statistically significant (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05, Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). The length of hospital stay between the two groups did not differ significantly (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The perioperative complications of dural sac tear (n\\u0026thinsp;=\\u0026thinsp;2) in the UBC group and dural sac tear (n\\u0026thinsp;=\\u0026thinsp;3) and incision infection (n\\u0026thinsp;=\\u0026thinsp;1, n\\u0026thinsp;=\\u0026thinsp;2) in the control group did not differ significantly (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). These complications subsided within one month after the operation. CSA did not differ significantly between the two groups after operation (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05), confirming that the decompression effect of the two groups after operation (UBC preoperative 0.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.09 vs. postoperative 1.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.05 cm\\u003csup\\u003e2\\u003c/sup\\u003e, control preoperative 0.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.08 vs. postoperative 1.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.04 cm\\u003csup\\u003e2\\u003c/sup\\u003e, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05, Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) was equivalent.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption\\u003e\\n\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n\\u003cp\\u003ePerioperative characteristics by type of procedure\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003c/caption\\u003e\\n\\u003cthead\\u003e\\n\\u003ctr\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eVariables\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eUBC(n\\u0026thinsp;=\\u0026thinsp;67)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eControl(n\\u0026thinsp;=\\u0026thinsp;61)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep-value\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/thead\\u003e\\n\\u003ctbody\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eOperative time, min\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e146.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.9\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e152.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.7\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.035*\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eEBL,ml\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e116.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.5\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e123.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.8\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.017*\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eLength of hospital stay (days)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e5.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.7\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e5.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.5\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.551\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePerioperative complications, n (%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e3\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e5\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.605\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eDural\\u0026nbsp;sac\\u0026nbsp;tearing\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2(3%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e3(4.9%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eIncision infection\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2(3.4%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd colspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n\\u003cp\\u003edural sac CSA, cm\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePreop\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.09\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.08\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.700\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1\\u0026nbsp;year postop\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.05\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.04\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.447\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eImprovement percentage of dural sac CSA(%)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e87.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20.3\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e89.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20.8\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.546\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eEBL, estimated blood loss;\\u003c/p\\u003e\\n\\u003cp\\u003eCSA, cross-sectional area\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e* indicates p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\\n\\u003cp\\u003eThe VAS, ODI, and ZCQ scores of the two groups were significantly improved at each follow-up time point than before the operation (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). One week after the operation, the VAS (2.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76) and ODI (35.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.55) scores were significantly better in the UBC group than in the control group (VAS: 3.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.90, ODI: 39.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.03, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05, Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). VAS and ODI scores did not differ significantly between the two groups at six months, one year, and two years after operation (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). ZCQ scores did not differ significantly between the two groups at each follow-up time point (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n\\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption\\u003e\\n\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n\\u003cp\\u003eComparison for postoperative VAS,ODI and ZCQ score\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003c/caption\\u003e\\n\\u003cthead\\u003e\\n\\u003ctr\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eScoring System\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eUBC(n\\u0026thinsp;=\\u0026thinsp;67)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eControl(n\\u0026thinsp;=\\u0026thinsp;61)\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003cth align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep-value\\u003c/p\\u003e\\n\\u003c/th\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/thead\\u003e\\n\\u003ctbody\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eVAS\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePreop (mean score)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e6.95\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.51\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e7.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.53\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.868\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePostop (1 wk)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e3.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.90\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.021*\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 6 mos\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2.36\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2.34\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.73\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.920\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 1 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1.94\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.69\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e2.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.61\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.134\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 2 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1.82\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.60\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e1.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.54\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.266\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep value (pre vs post)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eODI\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePreop (mean score)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e62.13\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.51\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e61.13\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.82\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.079\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePostop (1 wk)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e35.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.55\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e39.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.03\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.008**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 6 mos\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e16.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.40\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e16.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.41\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.659\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 1 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.36\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.48\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.523\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 2 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.92\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e12.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.88\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.236\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep value (pre vs post)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eZCQ\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd colspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePreop (mean score)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e66.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.57\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e66.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.31\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.062\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ePostop (1 wk)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e38.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.67\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e39.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.90\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.080\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 6 mos\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e22.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.10\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e21.59\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.72\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.258\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 1 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e19.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.39\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e20.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.97\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.219\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003eFollow-up at 2 yrs\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e18.71\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.74\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e19.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.77\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.220\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003ep value (pre vs post)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\n\\u003cp\\u003e0.000**\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eVAS,Visual Analogue Scale;\\u003c/p\\u003e\\n\\u003cp\\u003eODI,Oswestry Disability Index;\\u003c/p\\u003e\\n\\u003cp\\u003eZCQ,Zurich Claudication Questionnaire;\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e* indicates p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05,** indicates p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe ultrasonic bone curette converts the electrical signal into mechanical vibration via a piezoelectric converter, causing the knife head to vibrate at a high frequency and low amplitude. Due to the difference in tissue density and elasticity, most of the energy generated by ultrasonic bone curette is absorbed by hard bone tissue. It plays a role in bone cutting via mechanical fragmentation and cavitation effects. Soft tissues, such as nerve roots, dura mater, and spinal cord, are in elastic contact with the ultrasonic scalpel at the same frequency and amplitude, reducing the risk of direct damage to soft tissues [9,15]. Studies have demonstrated that ultrasonic bone knives can effectively avoid mechanical and thermal damage to nerve roots compared to high-speed grinding drills or traditional tools, such as vertebral plate bone rongeurs, bone knives, and pointed mouth bone rongeurs [16,17]. Morimoto et al. [18] discovered that ultrasonic osteotome for lumbar lamina fenestration and intervertebral foramen decompression in treating lumbar spinal stenosis has less surgical trauma and higher surgical safety than traditional osteotome and lamina rongeur. This study discovered that in clinical practice, an ultrasonic bone knife outperforms a high-speed grinding drill and a gun-shaped bone rongeur for spinal canal decompression. Severe DLSS mostly has ossified hard ligamentum flavum or intervertebral disc and severe bone hyperplasia. The pressure-causing substance is closely adhered to the dural sac and nerve root, with no buffer space [1,19]. If a high-speed grinding drill and gun-shaped bone rongeur are used for decompression, a brain cotton sheet and nerve stripper must be used to depress and protect the dura mater. The above operation of traditional tools in narrow spaces increases the difficulty and time of operation and increases the risk of nerve and dura mater injury. When the high-speed grinding drill is used, there is a situation of winding soft tissue, and the narrow space is unclear, which can easily cause the risk of dural and nerve root injury. Ultrasonic bone knife decompression requires only forcing the rake head to the back and grinding out the bone structure, reducing the risk of dural compression and nerve root injury. This study revealed that the postoperative dural sac CSA of the two groups was significantly higher than before surgery, with no significant difference in postoperative CSA between the two groups. Nerve root injury has no complications in the two groups. There were two cases of dural injury and three cases of cerebrospinal fluid leakage in the UBC and the control groups, respectively. The incidence between the two groups did not differ significantly. Therefore, we believe the ultrasonic bone knife is a safe and feasible tool in laminectomy, lateral recess decompression, and decompression surgery.\\u003c/p\\u003e \\u003cp\\u003ePrevious reports have achieved good clinical results using gun-shaped bone rongeur, high-speed grinding drill, or endoscopic unilateral fenestration to sneak out the hypertrophic ligamentum flavum, expand the lateral recess and nerve root canal, and expose and release the contralateral nerve root [20\\u0026ndash;21]. In this study, patients in the UBC group were treated with decompression of the contralateral spinal canal and nerve root canal using direct vision of an ultrasonic bone knife. The postoperative low back pain, intermittent claudication, and low back dysfunction were significantly relieved compared to those before the operation. VAS, ODI, and ZCQ scores did not differ significantly between the two groups during the mid-term follow-up (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Our study presented no significant difference in intervertebral fusion rate between the two groups at the last follow-up (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Therefore, we believe that MIS-TLIF with unilateral fenestration and bilateral decompression by ultrasonic bone knife can achieve similar mid-term clinical efficacy as traditional tool laminectomy decompression.\\u003c/p\\u003e \\u003cp\\u003eStudies have demonstrated that the high-frequency vibration of the contact surface between the blade and the bone tissue can produce thermal and cavitation effects during the removal of the lamina by the ultrasonic osteotome, thereby significantly reducing the bleeding of the bone tissue section [22]. The instantaneous high temperature generated at the interface between the ultrasonic bone knife and bone promotes the contraction of local microvessels and increases the thrombin activity, playing an important role in local hemostasis [22,23]. The cavitation effect of the ultrasonic bone knife is to strengthen the local coagulation function by emulsifying and breaking the surrounding soft tissue and promoting the coagulation and degeneration of hemoglobin [15,22,23]. Bone wax is frequently used to stop bleeding on the bone surface when traditional bone knives and gun-shaped bite forceps are used to remove the lamina. This method of hemostasis is rough and often incomplete, which is an important factor in increasing the amount of bleeding during the operation. Studies have revealed that using an ultrasonic bone knife for cervical laminectomy, thoracic laminectomy, and osteotomy in the scoliosis correction steps to treat the corresponding diseases resulted in less intraoperative blood loss than traditional laminectomy tools [15,22,23,24]. In this study, the ultrasonic bone knife group had significantly less intraoperative blood loss and postoperative drainage volume than the traditional group, consistent with previous reports. Therefore, we believe an ultrasonic bone knife is important in reducing bleeding during lumbar laminectomy and lateral recess decompression.\\u003c/p\\u003e \\u003cp\\u003eDLSS is more common in middle-aged and elderly patients. It is easy to cause clinical symptoms, such as low back pain, intermittent claudication, and radiation pain in both lower limbs, seriously affecting the patient\\u0026rsquo;s quality of life. MIS-TLIF is the most widely used and mature minimally invasive decompression and fusion technique. Unilateral fenestration and bilateral decompression mis-TLIF have been used in the surgical treatment of DLSS and have achieved good clinical results [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. However, severe DLSS mostly has ossified hard ligamentum flavum or intervertebral disc and severe bone hyperplasia. The dural sac and nerve root lack movement space and the pressure substance is closely adhered to the dural sac and nerve root, often without any buffer space. Conventional decompression tools can easily damage the dural sac and nerve root. The bone knife, lamina bite forceps for narrow segment laminectomy, nerve root canal enlargement, unilateral approach bilateral nerve root decompression, or bilateral establishment of channels for bilateral decompression are used in conventional MIS-TLIF surgery for severe lumbar spinal stenosis [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. This type of surgery has large trauma, more bleeding, and longer operation time, which can easily increase the incidence of perioperative complications [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. The operation time and bone-cutting efficiency of ultrasonic osteotome were significantly better than those of traditional tools. In this study, the operation time of the ultrasonic osteotome group was significantly shorter than that of the traditional group, consistent with previous research reports [22,23]. To solve the above problems, we adopted the ultrasonic bone knife-assisted unilateral approach bilateral decompression MIS-TLIF surgery to treat lumbar spinal stenosis, reducing intraoperative bleeding, shortening the operation time, and obtaining good clinical efficacy. In this study, the VAS and ODI scores of low back pain were better in the ultrasonic bone knife group than in the traditional group one week after the operation, possibly due to the stimulation and concussion of peripheral nerves by conventional tools (bone knife and vertebral plate bone biting forceps) in the traditional group. VAS, ODI, and ZCQ scores did not differ significantly between the two groups during the mid-term follow-up (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Therefore, we believe that MIS-TLIF assisted by ultrasonic bone knife has less trauma, faster recovery, and shorter operation time than the traditional tool group while achieving the same mid-term clinical efficacy. The long-term clinical efficacy still needs further follow-up. This is a retrospective clinical study. The evidence level is low, and the total number of cases is small. Prospective clinical studies of larger cases are needed.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eUltrasonic osteotome unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve similar mid-term clinical efficacy as traditional tool laminectomy decompression MIS-TLIF. It can reduce the operation time, intraoperative blood loss, and postoperative drainage. Short-term follow-up can reduce the degree of low back pain. It is a safe and effective surgical method. However, this is a retrospective clinical study. The evidence level is low, the sample size is small, and a prospective clinical study of larger cases is needed to prove further.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eDLSS Degenerative Lumbar Spinal Stenosis\\u003c/p\\u003e\\n\\u003cp\\u003eMIS-TLIF Minimally Invasive Transforaminal Lumbar Interbody Fusion\\u003c/p\\u003e\\n\\u003cp\\u003eUBC Ultrasonic Bone Curette\\u003c/p\\u003e\\n\\u003cp\\u003eVAS Visual Analogue Scale\\u003c/p\\u003e\\n\\u003cp\\u003eODI Oswestry disability index\\u003c/p\\u003e\\n\\u003cp\\u003eZCQ Zurich claudication score\\u003c/p\\u003e\\n\\u003cp\\u003eMRI Magnetic resonance imaging\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMinglei Shao and Tongxin Sun conceptualized and designed the study. Yuebing Ren performed an experiment and helped in the acquisition of data. Ying Nian and Minglei Shao were responsible for analysis and interpretation of data. Minglei Shao and Yuebing Ren helped to draft the manuscript. Yuebing Ren helped to revise the manuscript critically for important intellectual content. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon any reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the Ethics Committee of Dongying People \\u0026apos;s Hospital ( DYYX-2023-171 ). All participants provided informed written consent. All methods are in accordance with the relevant guidelines and regulations.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eKatz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688-1699. doi: 10.1001/jama.2022.5921.\\u003c/li\\u003e\\n\\u003cli\\u003eBumann H, N\\u0026uuml;esch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Sch\\u0026auml;ren S, M\\u0026uuml;ndermann A, Netzer C. Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking. Spine J. 2020;20(1):112-120. \\u003c/li\\u003e\\n\\u003cli\\u003eJacobi S, Beynon A, Dombrowski SU, Wedderkopp N, Witherspoon R, H\\u0026eacute;bert JJ. Effectiveness of Conservative Nonpharmacologic Therapies for Pain, Disability, Physical Capacity, and Physical Activity Behavior in Patients With Degenerative Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2021;102(11):2247-2260.e7. doi: 10.1016/j.apmr.2021.03.033.\\u003c/li\\u003e\\n\\u003cli\\u003eFoley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976). 2003;28(15 Suppl):S26-35. doi: 10.1097/01.BRS.0000076895.52418.5E.\\u003c/li\\u003e\\n\\u003cli\\u003eSmith WD, Wohns RN, Christian G, Rodgers EJ, Rodgers WB. Outpatient Minimally Invasive Lumbar Interbody: Fusion Predictive Factors and Clinical Results. Spine (Phila Pa 1976). 2016 ;41 Suppl 8:S106-22. doi:10.1097/BRS.0000000000001479. \\u003c/li\\u003e\\n\\u003cli\\u003eMcGirt MJ, Parker SL, Mummaneni P, Knightly J, Pfortmiller D, Foley K, Asher AL. Is the use of minimally invasive fusion technologies associated with improved outcomes after elective interbody lumbar fusion? Analysis of a nationwide prospective patient-reported outcomes registry. Spine J. 2017;17(7):922-932. doi: 10.1016/j.spinee.2017.02.003. \\u003c/li\\u003e\\n\\u003cli\\u003eMummaneni PV, Bisson EF, Kerezoudis P, Glassman S, Foley K, Slotkin JR, Potts E, Shaffrey M, Shaffrey CI, Coric D, Knightly J, Park P, Fu KM, Devin CJ, Chotai S, Chan AK, Virk M, Asher AL, Bydon M. Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database. Neurosurg Focus. 2017;43(2):E11. doi: 10.3171/2017.5.FOCUS17188.\\u003c/li\\u003e\\n\\u003cli\\u003eKhalifeh JM, Dibble CF, Stecher P, Dorward I, Hawasli AH, Ray WZ. Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device-Part I: 2-Dimensional Operative Video and Technical Report. Oper Neurosurg (Hagerstown). 2020;19(5):E473-E479. doi: 10.1093/ons/opaa100.\\u003c/li\\u003e\\n\\u003cli\\u003eAl-Mahfoudh R, Qattan E, Ellenbogen JR, Wilby M, Barrett C, Pigott T. Applications of the ultrasonic bone cutter in spinal surgery--our preliminary experience. Br J Neurosurg. 2014;28(1):56-60. doi: 10.3109/02688697.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang Zhenhui, Wang Qingde, Wang Zhongwei. Partitioned laminectomy assisted by ultrasonic bone knife Treatment of severe thoracic ossification of ligamentum flavum.Chinese journal of surgery. 2021, 59(11):940-946.doi: 10.3760/cma.j.cn112139-20210510-00207.\\u003c/li\\u003e\\n\\u003cli\\u003eMorimoto D, Isu T, Kim K, et al Microsurgical medial fenestration with an ultrasonic bone curette for lumbar foraminal stenosis. J Nippon Med Sch. 2012;79(5):327\\u0026ndash;334. doi: 10.1272/jnms.79.327.\\u003c/li\\u003e\\n\\u003cli\\u003eChen Xiaolin, Zeng Yan, Chen Zhongqiang.Comparison of the application of ultrasonic osteotome and traditional tools in the decompression and osteotomy of degenerative lumbar scoliosis. Chinese Journal of Spinal Cord 2017 ; 27 ( 5 ) : 418-422.doi : 10.3969 / j.issn.1004-406X.2017.05.06.\\u003c/li\\u003e\\n\\u003cli\\u003eSchizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976).2010;35(21):1919-24.doi: 10.1097/BRS.0b013e3181d359bd. \\u003c/li\\u003e\\n\\u003cli\\u003eBridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976). 1995;20(12):1410-8. \\u003c/li\\u003e\\n\\u003cli\\u003eHu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J. 2013;22(12):2845-9. doi: 10.1007/s00586-013-2780-y. \\u003c/li\\u003e\\n\\u003cli\\u003eHazer DB, Yaşar B, Rosberg HE, Akbaş A. Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients. Biomed Res Int. 2016;2016:8428530. doi: 10.1155/2016/8428530. \\u003c/li\\u003e\\n\\u003cli\\u003eOnen MR, Yuvruk E, Akay S, et al The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg. 2015;84(6):1962\\u0026ndash;1967. doi: 10.1016/j.wneu.2015.08.043.\\u003c/li\\u003e\\n\\u003cli\\u003eMorimoto D, Isu T, Kim K, et al Microsurgical medial fenestration with an ultrasonic bone curette for lumbar foraminal stenosis. J Nippon Med Sch. 2012;79(5):327\\u0026ndash;334. doi: 10.1272/jnms.79.327.\\u003c/li\\u003e\\n\\u003cli\\u003eBumann H, N\\u0026uuml;esch C, Loske S, Byrnes SK, Kovacs B, Janssen R, Sch\\u0026auml;ren S, M\\u0026uuml;ndermann A, Netzer C. Severity of degenerative lumbar spinal stenosis affects pelvic rigidity during walking. Spine J. 2020;20(1):112-120. doi: 10.1016/j.spine e.2019.08.016.\\u003c/li\\u003e\\n\\u003cli\\u003eTan B, Yang QY, Fan B, Xiong C. Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: A comparative study with decompression via open discectomy. Front Neurol. 2023;14:1132698. doi: 10.3389/fneur.2023.1132698. \\u003c/li\\u003e\\n\\u003cli\\u003eSanderson PL, Getty CJ Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine (Phila Pa 1976) 1996;21(11):1352\\u0026ndash;1356. doi: 10.1097/00007632-199606010-00015.\\u003c/li\\u003e\\n\\u003cli\\u003eLiu J, Kong Q, Feng P, Zhang B, Ma J, Hu Y. Analysis of the curative effect of cervical spondylotic radiculopathy with osseous foraminal stenosis using ultrasonic osteotome in anterior cervical surgery. BMC Musculoskelet Disord. 2023;24(1):81. doi: 10.1186/s12891-022-06083-1. \\u003c/li\\u003e\\n\\u003cli\\u003eKim K, Isu T, Matsumoto R, Isobe M, Kogure K. Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery.2006;59(4 Suppl 2): ONS390-3; discussion ONS393. doi: 10.1227/01.NEU.0000222655.69368.19.\\u003c/li\\u003e\\n\\u003cli\\u003eSanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. \\u003c/li\\u003e\\n\\u003cli\\u003eSanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci. 2011;18(11):1528-33. doi: 10.1016/j.jocn.2011.04.016. \\u003c/li\\u003e\\n\\u003cli\\u003eKang MS, You KH, Choi JY, Heo DH, Chung HJ, Park HJ. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J. 2021;21(12):2066-2077. doi: 10.1016/j.spinee.2021.06.013.\\u003c/li\\u003e\\n\\u003cli\\u003eGao QY, Wei FL, Li T, Zhu KL, Du MR, Heng W, Yang F, Gao HR, Qian JX, Zhou CP. Oblique Lateral Interbody Fusion vs. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis: A Retrospective Cohort Study. Front Med (Lausanne). 2022;9:829426.doi: 10.3389/fmed.2022.829426. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Ultrasonic bone curette, severe lumbar spinal stenosis, unilateral fenestration, bilateral decompression, MIS-TLIF\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3321439/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3321439/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e \\u003cp\\u003eWe aim to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MISTLIF) assisted by ultrasonic bone Curette (UBC) in treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MISTLIF in treating severe DLSS.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThe clinical data of 128 patients with single-segment severe DLSS admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using ultrasonic bone Curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate the low back pain before the operation, one week, and 1, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were used to evaluate the improvement of low back function. At the last follow-up, the Bridwell bone graft fusion standard was used to evaluate the bone graft fusion.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less than those in the control group (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The UBC group had better VAS and ODI scores than the control group one week after operation (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). VAS and ODI scores did not differ significantly between the two groups before, six months, one year, and two years after operation (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). ZCQ score did not differ significantly between the two groups before the operation, one week, six months, one year, and two years after the operation (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) at the last follow-up.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eUBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can obtain similar clinical efficacy as traditional tools unilateral fenestration bilateral decompression MIS-TLIF and can reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-up. It is a safe and effective surgical method.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Ultrasonic Bone Curette‐Assisted Unilateral approach for bilateral decompression with MISTLIF for Severe lumbar spinal stenosis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2023-09-08 13:47:18\",\"doi\":\"10.21203/rs.3.rs-3321439/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"29d5612b-78f0-4fe5-9051-7b1b49345ae1\",\"owner\":[],\"postedDate\":\"September 8th, 2023\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-02-09T13:14:21+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2023-09-08 13:47:18\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3321439\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3321439\",\"identity\":\"rs-3321439\",\"version\":[\"v1\"]},\"buildId\":\"_2-kVJe1T_tPrBINL-cwx\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}