To assess the clinical effectiveness of unilateral biportal endoscopy (UBE)  and  uniportal endoscopy (UE) in the management of lumbar spinal stenosis.

To assess the clinical effectiveness of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) in the management of 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 To assess the clinical effectiveness of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) in the management of lumbar spinal stenosis. 高 江, 孟 翔宇 This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4193917/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 To assess the clinical effectiveness of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) in the management of lumbar spinal stenosis. Methods Retrospective analysis was done on the clinical records of 61 patients with lumbar spinal stenosis treated with UBE or UE in the minimally invasive spine surgery department of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2023 and January 2024. The patients' average age was 66.4±12.5, and they included 24 males and 37 females. Using various surgical techniques, the patients were split into two groups: the UE group (33 cases) and the UBE group (28 cases). In order to assess the treatment scores, data on the two groups' operational times, intraoperative blood loss, visual analogue scales (VAS), and 0swestry Disability Index (0DI) were gathered and compared. The area of the dural sac and the angle of facet joint resection were determined based on preoperative and postoperative MRI and CT scans, and the problems were noted. Results Every patient had a successful surgical procedure.The intraoperative blood loss in the UBE group was 79.8±17.2ml, and the operative time was 68.7±9.8min.The group's UE was 71.5±10.8min and 73.5±21.7ml, respectively. There was no statistically significant difference between the groups (p>0.05).The two groups' post-operative VAS and ODI scores were lower than their pre-operative scores and exhibited a persistent downward trend. No statistically significant differences were found between the groups (p>0.05) in the variance analysis of the repeated measurement design.At the most recent follow-up, the rate of good and good showed no statistical significance (P>0.05).The dural sac area was (103.25±35.16) mm2 in the UE group and (126.73±42.74) mm2 in the UBE group (P<0.02).In the UBE group, the angle of lateral facet arthrotomy was 77.92°±12.17°, but in the UE group, it was 95.48°±11.98° (P<0.000). Conclusion Both UBE and UE have good short-term clinical efficacy in treating lumbar spinal stenosis; however, UBE has a better imaging decompression effect and can better preserve zygapophysial joint. Lumbar spinal stenosis unilateral biportal endoscopy uniportal endoscopy Figures Figure 1 Figure 2 Introduction Over the past few decades, lumbar spinal stenosis (LSS) has increased in the senior population, frequently resulting in symptoms of radiculopathy and nerve dysfunction [ 1 , 2 ] . When conservative treatment is ineffective for a patient, surgical manual intervention is typically necessary. Although it has a satisfactory clinical outcome when treating lumbar spinal stenosis, traditional open surgery can cause paravertebral muscle dissection, significant bleeding, and postoperative lumbar spine instability [ 3 ] . More research has demonstrated in recent years that uniportal endoscopy can treat lumbar spinal stenosis with clinical outcomes that are comparable to open surgery while requiring a smaller incision, less damage to the paravertebral muscle and spinal column bone structure, and a quicker recovery [ 4 – 8 ] .However, uniportal endoscopy (UE) has limits on surgical equipment, as the supporting surgical instruments are often small and the decompression time is prolonged. Currently, unilateral biportal endoscopy (UBE) technology is gaining popularity. Unilateral biportal endoscopy (UBE) has a large field of vision and may use typical open surgical equipment, which significantly enhances the efficiency of decompression and generates good clinical results in the treatment of lumbar spinal stenosis [ 9 – 10 ] .In order to examine the clinical effectiveness and spinal decompression effect of the two surgical techniques, this study retrospectively analyzed the data of patients with lumbar spinal stenosis treated with UBE or UE in the minimally invasive spinal surgery department of the Sixth Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024. Materials and methods Criteria for inclusion and removal Inclusion criteria ① Conservative therapy is unsuccessful for neurological claudication symptoms that last longer than three months;;② Imaging revealed dural sac compression, nerve compression, and spinal stenosis with or without lumbar disc herniation. The spinal canal was clearly small, and the articular zygapophysial joint and ligamentum flavum were hyperplasia. Exclusion criteria ① Less than six months had passed since the follow-up, and the data were incomplete.; ② Lumbar spinal stenosis with more than two segments;③ When coupled with significant underlying illnesses or mental health or other cognitive impairments, it can impact functional assessment༛④ Previous lumbar surgery history༛ General details The Sixth Affiliated Hospital of Xinjiang Medical University's minimally invasive spinal surgery department treated 61 patients with lumbar spinal stenosis using UBE or UE between January 2023 and January 2024;Using various surgical techniques, they were split into two groups: the UE group (n = 33) and the UBE group (n = 28), Age, surgery stage, and sex ratio did not differ statistically between the two groups (P > 0.05, Table 1 ). Table 1 Comparing the two groups' general data UBE Group UE Group P value No.of patients 28 33 Sex: M/F 16/12 8/25 Age in yrs 68.1 ± 9.8 65 ± 14.4 0.32 operative segment 0.74 L3/4 3 2 L4/5 24 29 L5/S1 1 2 Note: UBE, unilateral biportal endoscopy; UE, uniportal endoscopy Surgery UBE Following the onset of anesthesia, the patient lies prone, with their abdomen hanging and their waist slightly elevated. In order to ascertain the target segment laminar space, C-arm positive fluoroscopy. At the intersection of the medial edge of the pedicle and the intervertebral space of the responsible segment, which is 1–2 cm above and below, operation incisions were made and examined.The proximal end was employed as the observation channel, the distal incision served as the operation channel, and a radiofrequency knife was used to remove soft tissue from the laminae's surface.revealing the ligamenta flavum, the superior border of the lower vertebral body's laminae, and the articular junction of the upper and lower zygapophysial joint,Using bone knives and gun forceps, the medial margins of the inferior articular processes of the upper and lower vertebral bodies were removed. The spinal canal and nerve root canal were then expanded until the dural sac pulsated normally, the blood vessels on the nerve root's surface were filled, the nerve root was released, and ipsilateral decompression was finished.A portion of the bone was extracted along the spinous process root, the contralateral yellow ligament was bitten and exfoliated, the zygapophysial joint were located, the dural sac and nerve root were revealed, and contralateral decompression was carried out in the same manner.After inserting a drainage tube and suturing the wound, sterile gauze was used to bandage the incision. UE: Following the onset of anesthesia, the patient lies prone, with their abdomen hanging and their waist slightly elevated. C-arm perspective was used to determine the intended interlaminar space. On the horizontal side of the responsibility space, the puncture point was located 3 cm from the spinous process's midline. Following standard cleaning and dressing, the puncture site had a skin incision of approximately 0.8 cm.The responsible segment's facet joint was reached by puncturing the pencil lead along the puncture site. The pencil lead was then placed into the working channel and the spinal endoscope through the working channel.The dural sac and nerve root were exposed, the hyperplastic bone and ligamenta flavum were removed, a portion of the zygapophysial joint were removed, and the foramen was widened.The contralateral yellow ligament was bitten, and the contralateral nerve root was exposed and loosened. After decompression and decompression, the nerve root was investigated and no pressure was found, and no obvious bleeding was found. The working channel was removed, the incision was sutured, and sterile gauze was wrapped. Postoperative management Individuals in both cohorts received the same regimen of fluid replacement, low-dose hormones, and analgesic medications on a regular basis. Lower extremity pressure and anticoagulant medication should be administered to elderly people in order to prevent lower extremity venous thrombosis.No patients with unique circumstances were told to wear waist circumference clothing to get out of bed on the second day of the procedure, and the drainage tube was withdrawn from the UBE group within 48 hours of the procedure. Index of postoperative observation Both groups' operating times, intraoperative blood losses, and complications were noted.① Scores on the visual analog scale (VAS) for leg and lumbar pain three months, and six months prior to and following surgery;② Scores on the Oswestry Disability Index (ODI) three and six months prior to and following surgery༛③ The Macnab criteria were used to measure effectiveness [ 11 ] . Excellent: all symptoms go away, and one can resume their previous activities and way of life; Positive: Occasionally painful, capable of light labor; Can: symptoms have subsided but pain persists and prevents work; Bad: Indices of compression of the nerve roots, necessitating additional surgery. The two groups' clinical outcomes were contrasted and examined.④Area of the dural sac.Three T2WI cross-sections were successively obtained in the lumbar diseased region at a horizontal intervertebral disc spacing of three millimeters [ 12 ] .. Plotting the dural sac boundary allowed for the calculation of the three layers' average dural sac cross-sectional area.⑤The angle of facetectomy resection, which is the angle of the similar side's internal facet's lateral and axial horizontal lines on the lumbar spine's transverse CT scan following surgery; Statistical analysis The distribution of the measurement data was examined for normalcy using the Kolmogorov-Smirnov test. According to a normal test, the measurement data (mean ± standard deviation) and operation duration, intraoperative blood loss, VAS, ODI, dural sac area, and facet joint resection angle) all fit the normal distribution. The analysis of variance repeated measurements was utilized to compare the two groups at various intervals, and the independent Student’s t test was employed for that purpose.The Fisher exact probability approach or the Chi-square test were applied to different data sets. Statistical significance was defined as P < 0.05. Results With no nerve damage or dural tear, every patient underwent a successful procedure.UBE group and UE group operated for 68.7 ± 9.8 and 71.5 ± 10.8 minutes, respectively. There was no statistically significant difference in the intraoperative blood loss (79.8 ± 17.2) and (73.5 ± 21.7) ml (P > 0.05, Table 2 ). Table 2 Comparison of the two groups' surgical indices UBE Group UE Group P value Operative time(min) 68.7 ± 9.8 71.5 ± 10.8 0.29 Intraoperative blood(ml) 79.8 ± 17.2 73.5 ± 21.7 0.21 Clinical effectiveness assessment Both groups' patients were monitored. The two groups' ODI scores, VAS scores for leg pain, and VAS ratings for low back pain all improved over the pre-surgery scores at all time periods, and there was no statistically significant difference throughout (P > 0.05, Table 3 ). In the two groups, Macnab's excellent and good rates were 20 at excellent, 7 at good, and 1 at acceptable. The curative impact of UE was found to be excellent in 22 cases, good in 9 cases, and fair in 2 cases. The difference in the excellent and good rates between the two groups was not statistically significant (P > 0.05, Table 3 ). Table 3 Comparing the two groups' clinical efficacy UBE Group UE Group P value VAS of low back pain Pre-op 4.75 ± 1.37 4.24 ± 1.58 0.19 Post-op 3 months 2.14 ± 0.93 2.09 ± 0.91 0.82 Final FU 0.92 ± 0.81 0.84 ± 0.71 0.68 VAS leg pain score Pre-op 7.28 ± 0.80 7.03 ± 0.80 0.22 Post-op 3 months 2.64 ± 0.98 2.39 ± 0.93 0.31 Final FU 1.07 ± 0.85 1.15 ± 0.90 0.72 ODI Preop 61.39 ± 6.92 59.42 ± 8.66 0.33 Post-op 3 months 28.39 ± 9.18 24.60 ± 7.51 0.08 Final FU 11.60 ± 5.83 8.87 ± 5.85 0.07 Macnab 96%(27/28) 93%(31/33) 0.66 Comparing the findings of imaging Prior to surgery, the dural sac areas of UBE and UE were (61.92 ± 23.57) mm2 and (63.14 ± 19.62) mm2, respectively. Following the procedure, these areas increased to (126.73 ± 42.74) mm2 and (103.25 ± 35.16) mm2, respectively.The postoperative dural sac area in the UBE group was substantially bigger than that in the UE group (P < 0.02, Table 4 ), but the preoperative dural sac area did not differ statistically between the two groups.UBE and UE groups had angle of facetectomy of 77.92°±12.17° and 95.48°±11.98°, respectively. The difference between the two groups was statistically significant, with the UBE group having a higher angle than the UE group (P < 0.000, Table 4 ).The two groups' typical situations are depicted in Figs. 1 and 2 , respectively. Table 4 Comparing the findings of imaging UBE Group UE Group P value Pre-Dural areas 61.92 ± 23.57 63.14 ± 19.62 0.82 Post-Dural areas 126.73 ± 42.74 103.25 ± 35.16 0.02 angle of facetectomy 77.92 ± 12.17 95.48 ± 11.98 0.000 Complication Four UBE group patients experienced inadequate relief of nerve root symptoms following surgery. These patients' symptoms improved with symptomatic treatment, such as intravenous infusions of hormone and mannitol, which was thought to be connected to nerve edema.Symptomatic therapy was provided for two cases of postoperative epidural hematoma in the UE group. Discussion Lumbar spinal stenosis (LSS) is treated with complete decompression, nerve compression alleviation.But in order to remove the proliferating articular osteophytes and ligaments, decompression should be predicated on the reduction of normal structural damage,less injury to the skin, paravertebral muscles, ligaments, and zygapophysial joint [ 13 ] .Traditional and efficient surgical methods to treat lumbar spinal stenosis [ 14 ] ,however, postoperative discomfort, muscle atrophy, iatrogenic spinal instability, neighboring segment degeneration, and perioperative blood loss might result from iatrogenic damage of the posterior spinal structure [ 15 ] . Reduction of intraoperative trauma, reduction of blood loss, reduction of the detrimental effect on muscles, ligaments, and other anatomical structures, and reduction of the length of the postoperative recovery period are the hallmarks of current spinal endoscopic treatment. The results of uniportal endoscopy surgery for lumbar stenosis are satisfactory, but there is a danger of nerve damage, a lengthy learning curve, and certain decompression treatments are carried out in the blind area. In addition, damage to the ipsilateral facet joint during ipsilateral pressure reduction may occur as a result of equipment selection and flexibility limitations, which could influence the decompression effect. unilateral biportal endoscopy differs from uniportal endoscopy in that it uses endoscopic surgery instead of typical posterior open surgery. As unilateral biportal endoscopy surgery has advanced quickly, so have its indications. It is now able to treat a variety of conditions, such as grade I lumbar spondylolisthesis, moderate to severe disc herniation with or without mild instability, and moderate to severe spinal stenosis, including central and lateral recess and foraminal stenosis [ 16 ] . It also offers additional benefits for treating spinal stenosis. The two minimally invasive procedures now aim to reduce stress to the normal tissue of the spine, as well as to muscle, bone, and zygapophysial joint. Nevertheless, there are still considerable distinctions between the two decompression methods.With uniportal endoscopy, for instance, the operating channel and endoscope are integrated, and intraoperative surgical instrument loss is virtually nonexistent. Simultaneously, the uniportal endoscopy approach reduces surgical damage and eliminates the need for a second manual incision to prepare the working channel. In contrast to many endoscopic techniques, Choi et al [ 17 ] demonstrated that UE had the least amount of paraspinal muscle damage and the lowest levels of CRP following surgery. The uniportal endoscopy can be performed under local anesthetic on elderly individuals who are not able to endure general anesthesia. The observation channel and the operation channel are inverted triangles that are free to move independently of one another, tilt at will, have an extensive activity space, and are not constrained by the sleeve. It can freely cross the midline and enter the contralateral spinal canal during contralateral decompression, which can offer enough room for operation and a nice near observation field for bilateral spinal canal exploration. Unilateral laminectomy is one method of achieving bilateral spinal canal decompression.The decompression efficiency of the arthroscopes used during the procedure is substantially increased when they are equipped with open surgical instruments and can select between 0° and 30° lenses, the latter of which offers a broader viewing angle range. However, there are contraindications for individuals who have serious problems, and this procedure is challenging to execute under local anesthesia. Reduced volume in the spinal canal, neural canal, and foramen, together with pain in the legs and back from compressed nerves, are the causes of spinal stenosis. Thus, the objective of both techniques is to efficiently increase the spinal canal volume while maintaining a greater number of zygapophysial joint. According to Heo DH et al [ 9 ] , a good decompression effect can be obtained with an angle of facet joint excision < 90%. This investigation's results were in line with Heo D. H.'s findings [ 9 ] ,, as the arthroplasty Angle of UBE was less than UE and less than 90°. Experience with Heo surgery, however, indicates that the surgeon's skill rather than the technique used during surgery may be the determining factor in facet joint preservation. Heo D H [ 9 ] measured the postoperative dural sac area to assess the effect of compression. Findings were consistent with this study's measurement results: the UBE group's dural sac area was substantially greater than the UE group's. The dural sac area of both groups was significantly enlarged compared with that of the preoperative group, and the UBE group was larger than that of the UE group. The reason might be that the UBE observation channel and the operation channel are not attached to each other. Additionally, the operation tool's flexibility is higher, its angle is variable, and its field of vision is wider, allowing it to probe the spinal canal in all directions for more thorough decompression. Both groups' postoperative follow-up VAS and ODI scores for leg and lumbar pain showed statistically significant improvements over preoperative levels, and both groups were able to attain favorable clinical outcomes. According to studies [ 18 ] , there is a larger chance of difficulties in the early stages of surgery (the first 50 cases), and perioperative issues of UBE surgery tend to emerge during the first learning and surgical progression phases. Incomplete decompression, nerve damage, dural tears, epidural hematomas, and other common complications have been documented in earlier research [ 19 ] .The two groups in this study did not experience any of the aforementioned problems. However, because endoscopic equipment is highly specialized, difficulties were common in the early stages of endoscope learning. There are certain restrictions on this study: First of all, the study is retrospective and has little supporting data. Furthermore, because of the limited sample size and short follow-up period, a larger sample should be used for future long-term follow-up. Conclusion While UE and UBE can both effectively cure lumbar spinal stenosis in the short term, UBE has a greater ability to preserve zygapophysial joint and has a stronger decompression effect on imaging test results. Declarations Acknowledgements We are grateful to the doctors who contributed to this paper. Author contributions Conception and study design— Meng Xiangyu;data acquisition; data analysis and interpretation—Gaojiang ;drafting the article— Gaojiang Funding None Data availability No datasets were generated or analysed during the current study. Declarations Ethics approval and consent to participate The experimental protocol was developed according to the Declaration of Helsinki ethical guidelines and approved by the Ethics Committee of the Sixth Affiliated Hospital of Xinjiang Medical University. Written informed consent was obtained from the participants. Competing interests The authors declare no competing interests. References Lafian AM, Torralba KD. Lumbar Spinal Stenosis in Older Adults. Rheum Dis Clin North Am. 2018;44(3):501–12. https://doi:10.1016/j.rdc.2018.03.008 . Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358(8):818–25. 10.1056/NEJMcp0708097 . https:// . Sriphirom P, Siramanakul C, Chaipanha P, Saepoo C. Clinical Outcomes of Interlaminar Percutaneous Endoscopic Decompression for Degenerative Lumbar Spondylolisthesis with Spinal Stenosis. Brain Sci. 2021;11(1):83. https://doi:10.3390/brainsci11010083 . Pokorny G, Amaral R, Marcelino F, Moriguchi R, Barreira I, Yozo M, Pimenta L. Minimally invasive versus open surgery for degenerative lumbar pathologies:a systematic review and meta-analysis. Eur Spine J. 2022;31(10):2502–26. .https://doi:10.1007/s00586-022-07327-3 . Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. 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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-4193917","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":287714154,"identity":"dcdf55db-3be2-48a8-b36b-0d0d845d4c20","order_by":0,"name":"高 江","email":"","orcid":"","institution":"the Sixth Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"高","middleName":"","lastName":"江","suffix":""},{"id":287714155,"identity":"46444bb1-b557-4dc7-92c8-e323a475f807","order_by":1,"name":"孟 翔宇","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACNmbGxsc/Kmx4GOc/PkCcFj725mZjhjNpcswNaQnEaZHjOd4mzNhy2Ji9IceASIdJJLYxFzakJfY2nPl44w2DnZxuAxFaHs/cYZM4s7F3s+UchmRjswOEtbQb8J5JS9zYzLtNmofhQOI2IrS0SfC2HU7cf4znGZFaeA62SQO1GDP28LARqYW9sdlwBjCQGWewGVvOMSDCL/LN7A8ffABF5QzmhzfeVNjJEdSCAiR4iIwaZC2k6hgFo2AUjIIRAQC2VUR51ohmbQAAAABJRU5ErkJggg==","orcid":"","institution":"the Sixth Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"孟","middleName":"","lastName":"翔宇","suffix":""}],"badges":[],"createdAt":"2024-03-31 01:59:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4193917/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4193917/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54394857,"identity":"d164e9fe-d7d9-4552-ab2b-1d3f3a0a8c1a","added_by":"auto","created_at":"2024-04-09 21:13:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":626543,"visible":true,"origin":"","legend":"\u003cp\u003eshows the results of unilateral biportal endoscopy decompression for a 57-year-old male with L4/5 spinal stenosis.A lumbar spine preoperative anteroposterior X-ray revealed the L4/5 intervertebral space to be narrowed;B and C Spinal canal stenosis and dural sac compression were observed on preoperative MRIs in the sagittal and cross sections. D, E L4/5 spinal canal stenosis and ligamenta flandum hypertrophy were seen in the preoperative sagittal CT reconstruction and lumbar spine cross section.F, G Dilated dural sac and decompression of the spinal canal were visible on postoperative MRI sagittal and cross sections.H,I. The facet joint was in good condition, and the lumbar spine's postoperative sagittal CT reconstruction and transverse L4/5 spinal canal decompression was completed.\u003c/p\u003e","description":"","filename":"F1.png","url":"https://assets-eu.researchsquare.com/files/rs-4193917/v1/8e343f4b2445c8191f536400.png"},{"id":54394856,"identity":"2a5ea79d-411a-43e3-9894-8512a154e42a","added_by":"auto","created_at":"2024-04-09 21:13:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":629725,"visible":true,"origin":"","legend":"\u003cp\u003euniportal endoscopy decompression was performed on a 53-year-old female patient with L4/5 spinal stenosis.A lumbar spine preoperative anteroposterior X-ray revealed bone development at L4/5 and vertebral space stenosis.B，C Spinal canal stenosis and dural sac compression were observed on preoperative MRIs in the sagittal and cross sections.D,E Preoperative lumbar vertebral cross section and sagittal CT reconstruction revealed L4/5 spinal stenosis.F,GDecompression of the spinal canal and dilating of the dural sac were observed on sagittal and cross-sectional MRI.H,ITransverse L4/5 spinal canal decompression and postoperative sagittal CT reconstruction of the lumbar spine were finished, with minimal facet joint retention.\u003c/p\u003e","description":"","filename":"F2.png","url":"https://assets-eu.researchsquare.com/files/rs-4193917/v1/7a47940e5d18a0298070b738.png"},{"id":54772304,"identity":"b5f8033b-e18b-45fd-9c90-eb8539070991","added_by":"auto","created_at":"2024-04-16 14:36:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1407451,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4193917/v1/2cb4fd83-0893-4382-bae1-efc9993b8454.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"To assess the clinical effectiveness of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) in the management of lumbar spinal stenosis.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past few decades, lumbar spinal stenosis (LSS) has increased in the senior population, frequently resulting in symptoms of radiculopathy and nerve dysfunction\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. When conservative treatment is ineffective for a patient, surgical manual intervention is typically necessary. Although it has a satisfactory clinical outcome when treating lumbar spinal stenosis, traditional open surgery can cause paravertebral muscle dissection, significant bleeding, and postoperative lumbar spine instability\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. More research has demonstrated in recent years that uniportal endoscopy can treat lumbar spinal stenosis with clinical outcomes that are comparable to open surgery while requiring a smaller incision, less damage to the paravertebral muscle and spinal column bone structure, and a quicker recovery\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.However, uniportal endoscopy (UE) has limits on surgical equipment, as the supporting surgical instruments are often small and the decompression time is prolonged. Currently, unilateral biportal endoscopy (UBE) technology is gaining popularity. Unilateral biportal endoscopy (UBE) has a large field of vision and may use typical open surgical equipment, which significantly enhances the efficiency of decompression and generates good clinical results in the treatment of lumbar spinal stenosis\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.In order to examine the clinical effectiveness and spinal decompression effect of the two surgical techniques, this study retrospectively analyzed the data of patients with lumbar spinal stenosis treated with UBE or UE in the minimally invasive spinal surgery department of the Sixth Affiliated Hospital of Xinjiang Medical University from January 2023 to January 2024.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCriteria for inclusion and removal\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003e① Conservative therapy is unsuccessful for neurological claudication symptoms that last longer than three months;;② Imaging revealed dural sac compression, nerve compression, and spinal stenosis with or without lumbar disc herniation. The spinal canal was clearly small, and the articular zygapophysial joint and ligamentum flavum were hyperplasia.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003e① Less than six months had passed since the follow-up, and the data were incomplete.; ② Lumbar spinal stenosis with more than two segments;③ When coupled with significant underlying illnesses or mental health or other cognitive impairments, it can impact functional assessment༛④ Previous lumbar surgery history༛\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eGeneral details\u003c/h2\u003e \u003cp\u003eThe Sixth Affiliated Hospital of Xinjiang Medical University's minimally invasive spinal surgery department treated 61 patients with lumbar spinal stenosis using UBE or UE between January 2023 and January 2024;Using various surgical techniques, they were split into two groups: the UE group (n\u0026thinsp;=\u0026thinsp;33) and the UBE group (n\u0026thinsp;=\u0026thinsp;28), Age, surgery stage, and sex ratio did not differ statistically between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing the two groups' general data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex: M/F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8/25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoperative segment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5/S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: UBE, unilateral biportal endoscopy; UE, uniportal endoscopy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSurgery\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eUBE\u003c/strong\u003e \u003cp\u003eFollowing the onset of anesthesia, the patient lies prone, with their abdomen hanging and their waist slightly elevated. In order to ascertain the target segment laminar space, C-arm positive fluoroscopy. At the intersection of the medial edge of the pedicle and the intervertebral space of the responsible segment, which is 1\u0026ndash;2 cm above and below, operation incisions were made and examined.The proximal end was employed as the observation channel, the distal incision served as the operation channel, and a radiofrequency knife was used to remove soft tissue from the laminae's surface.revealing the ligamenta flavum, the superior border of the lower vertebral body's laminae, and the articular junction of the upper and lower zygapophysial joint,Using bone knives and gun forceps, the medial margins of the inferior articular processes of the upper and lower vertebral bodies were removed. The spinal canal and nerve root canal were then expanded until the dural sac pulsated normally, the blood vessels on the nerve root's surface were filled, the nerve root was released, and ipsilateral decompression was finished.A portion of the bone was extracted along the spinous process root, the contralateral yellow ligament was bitten and exfoliated, the zygapophysial joint were located, the dural sac and nerve root were revealed, and contralateral decompression was carried out in the same manner.After inserting a drainage tube and suturing the wound, sterile gauze was used to bandage the incision.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eUE: Following the onset of anesthesia, the patient lies prone, with their abdomen hanging and their waist slightly elevated. C-arm perspective was used to determine the intended interlaminar space. On the horizontal side of the responsibility space, the puncture point was located 3 cm from the spinous process's midline. Following standard cleaning and dressing, the puncture site had a skin incision of approximately 0.8 cm.The responsible segment's facet joint was reached by puncturing the pencil lead along the puncture site. The pencil lead was then placed into the working channel and the spinal endoscope through the working channel.The dural sac and nerve root were exposed, the hyperplastic bone and ligamenta flavum were removed, a portion of the zygapophysial joint were removed, and the foramen was widened.The contralateral yellow ligament was bitten, and the contralateral nerve root was exposed and loosened. After decompression and decompression, the nerve root was investigated and no pressure was found, and no obvious bleeding was found. The working channel was removed, the incision was sutured, and sterile gauze was wrapped.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative management\u003c/h2\u003e \u003cp\u003eIndividuals in both cohorts received the same regimen of fluid replacement, low-dose hormones, and analgesic medications on a regular basis. Lower extremity pressure and anticoagulant medication should be administered to elderly people in order to prevent lower extremity venous thrombosis.No patients with unique circumstances were told to wear waist circumference clothing to get out of bed on the second day of the procedure, and the drainage tube was withdrawn from the UBE group within 48 hours of the procedure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eIndex of postoperative observation\u003c/h2\u003e \u003cp\u003eBoth groups' operating times, intraoperative blood losses, and complications were noted.① Scores on the visual analog scale (VAS) for leg and lumbar pain three months, and six months prior to and following surgery;② Scores on the Oswestry Disability Index (ODI) three and six months prior to and following surgery༛③ The Macnab criteria were used to measure effectiveness\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Excellent: all symptoms go away, and one can resume their previous activities and way of life; Positive: Occasionally painful, capable of light labor; Can: symptoms have subsided but pain persists and prevents work; Bad: Indices of compression of the nerve roots, necessitating additional surgery. The two groups' clinical outcomes were contrasted and examined.④Area of the dural sac.Three T2WI cross-sections were successively obtained in the lumbar diseased region at a horizontal intervertebral disc spacing of three millimeters\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.. Plotting the dural sac boundary allowed for the calculation of the three layers' average dural sac cross-sectional area.⑤The angle of facetectomy resection, which is the angle of the similar side's internal facet's lateral and axial horizontal lines on the lumbar spine's transverse CT scan following surgery;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe distribution of the measurement data was examined for normalcy using the Kolmogorov-Smirnov test. According to a normal test, the measurement data (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation) and operation duration, intraoperative blood loss, VAS, ODI, dural sac area, and facet joint resection angle) all fit the normal distribution. The analysis of variance repeated measurements was utilized to compare the two groups at various intervals, and the independent Student\u0026rsquo;s t test was employed for that purpose.The Fisher exact probability approach or the Chi-square test were applied to different data sets. Statistical significance was defined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWith no nerve damage or dural tear, every patient underwent a successful procedure.UBE group and UE group operated for 68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8 and 71.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 minutes, respectively. There was no statistically significant difference in the intraoperative blood loss (79.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.2) and (73.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7) ml (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the two groups' surgical indices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e71.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e79.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eClinical effectiveness assessment\u003c/h2\u003e \u003cp\u003eBoth groups' patients were monitored. The two groups' ODI scores, VAS scores for leg pain, and VAS ratings for low back pain all improved over the pre-surgery scores at all time periods, and there was no statistically significant difference throughout (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the two groups, Macnab's excellent and good rates were 20 at excellent, 7 at good, and 1 at acceptable. The curative impact of UE was found to be excellent in 22 cases, good in 9 cases, and fair in 2 cases. The difference in the excellent and good rates between the two groups was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing the two groups' clinical efficacy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUBE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS of low back pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal FU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS leg pain score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal FU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.42\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal FU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.87\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacnab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96%(27/28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93%(31/33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparing the findings of imaging\u003c/h2\u003e \u003cp\u003ePrior to surgery, the dural sac areas of UBE and UE were (61.92\u0026thinsp;\u0026plusmn;\u0026thinsp;23.57) mm2 and (63.14\u0026thinsp;\u0026plusmn;\u0026thinsp;19.62) mm2, respectively. Following the procedure, these areas increased to (126.73\u0026thinsp;\u0026plusmn;\u0026thinsp;42.74) mm2 and (103.25\u0026thinsp;\u0026plusmn;\u0026thinsp;35.16) mm2, respectively.The postoperative dural sac area in the UBE group was substantially bigger than that in the UE group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.02, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), but the preoperative dural sac area did not differ statistically between the two groups.UBE and UE groups had angle of facetectomy of 77.92\u0026deg;\u0026plusmn;12.17\u0026deg; and 95.48\u0026deg;\u0026plusmn;11.98\u0026deg;, respectively. The difference between the two groups was statistically significant, with the UBE group having a higher angle than the UE group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).The two groups' typical situations are depicted in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparing the findings of imaging\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUBE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUE Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-Dural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e61.92\u0026thinsp;\u0026plusmn;\u0026thinsp;23.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e63.14\u0026thinsp;\u0026plusmn;\u0026thinsp;19.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Dural areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e126.73\u0026thinsp;\u0026plusmn;\u0026thinsp;42.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e103.25\u0026thinsp;\u0026plusmn;\u0026thinsp;35.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eangle of facetectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e77.92\u0026thinsp;\u0026plusmn;\u0026thinsp;12.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e95.48\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComplication\u003c/h2\u003e \u003cp\u003eFour UBE group patients experienced inadequate relief of nerve root symptoms following surgery. These patients' symptoms improved with symptomatic treatment, such as intravenous infusions of hormone and mannitol, which was thought to be connected to nerve edema.Symptomatic therapy was provided for two cases of postoperative epidural hematoma in the UE group.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLumbar spinal stenosis (LSS) is treated with complete decompression, nerve compression alleviation.But in order to remove the proliferating articular osteophytes and ligaments, decompression should be predicated on the reduction of normal structural damage,less injury to the skin, paravertebral muscles, ligaments, and zygapophysial joint\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.Traditional and efficient surgical methods to treat lumbar spinal stenosis\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e,however, postoperative discomfort, muscle atrophy, iatrogenic spinal instability, neighboring segment degeneration, and perioperative blood loss might result from iatrogenic damage of the posterior spinal structure\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Reduction of intraoperative trauma, reduction of blood loss, reduction of the detrimental effect on muscles, ligaments, and other anatomical structures, and reduction of the length of the postoperative recovery period are the hallmarks of current spinal endoscopic treatment. The results of uniportal endoscopy surgery for lumbar stenosis are satisfactory, but there is a danger of nerve damage, a lengthy learning curve, and certain decompression treatments are carried out in the blind area. In addition, damage to the ipsilateral facet joint during ipsilateral pressure reduction may occur as a result of equipment selection and flexibility limitations, which could influence the decompression effect. unilateral biportal endoscopy differs from uniportal endoscopy in that it uses endoscopic surgery instead of typical posterior open surgery. As unilateral biportal endoscopy surgery has advanced quickly, so have its indications. It is now able to treat a variety of conditions, such as grade I lumbar spondylolisthesis, moderate to severe disc herniation with or without mild instability, and moderate to severe spinal stenosis, including central and lateral recess and foraminal stenosis\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. It also offers additional benefits for treating spinal stenosis. The two minimally invasive procedures now aim to reduce stress to the normal tissue of the spine, as well as to muscle, bone, and zygapophysial joint. Nevertheless, there are still considerable distinctions between the two decompression methods.With uniportal endoscopy, for instance, the operating channel and endoscope are integrated, and intraoperative surgical instrument loss is virtually nonexistent. Simultaneously, the uniportal endoscopy approach reduces surgical damage and eliminates the need for a second manual incision to prepare the working channel. In contrast to many endoscopic techniques, Choi et al\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e demonstrated that UE had the least amount of paraspinal muscle damage and the lowest levels of CRP following surgery. The uniportal endoscopy can be performed under local anesthetic on elderly individuals who are not able to endure general anesthesia. The observation channel and the operation channel are inverted triangles that are free to move independently of one another, tilt at will, have an extensive activity space, and are not constrained by the sleeve. It can freely cross the midline and enter the contralateral spinal canal during contralateral decompression, which can offer enough room for operation and a nice near observation field for bilateral spinal canal exploration. Unilateral laminectomy is one method of achieving bilateral spinal canal decompression.The decompression efficiency of the arthroscopes used during the procedure is substantially increased when they are equipped with open surgical instruments and can select between 0\u0026deg; and 30\u0026deg; lenses, the latter of which offers a broader viewing angle range. However, there are contraindications for individuals who have serious problems, and this procedure is challenging to execute under local anesthesia. Reduced volume in the spinal canal, neural canal, and foramen, together with pain in the legs and back from compressed nerves, are the causes of spinal stenosis. Thus, the objective of both techniques is to efficiently increase the spinal canal volume while maintaining a greater number of zygapophysial joint. According to Heo DH et al\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, a good decompression effect can be obtained with an angle of facet joint excision\u0026thinsp;\u0026lt;\u0026thinsp;90%. This investigation's results were in line with Heo D. H.'s findings\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e,, as the arthroplasty Angle of UBE was less than UE and less than 90\u0026deg;. Experience with Heo surgery, however, indicates that the surgeon's skill rather than the technique used during surgery may be the determining factor in facet joint preservation.\u003c/p\u003e \u003cp\u003eHeo D H\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003emeasured the postoperative dural sac area to assess the effect of compression. Findings were consistent with this study's measurement results: the UBE group's dural sac area was substantially greater than the UE group's. The dural sac area of both groups was significantly enlarged compared with that of the preoperative group, and the UBE group was larger than that of the UE group. The reason might be that the UBE observation channel and the operation channel are not attached to each other. Additionally, the operation tool's flexibility is higher, its angle is variable, and its field of vision is wider, allowing it to probe the spinal canal in all directions for more thorough decompression.\u003c/p\u003e \u003cp\u003eBoth groups' postoperative follow-up VAS and ODI scores for leg and lumbar pain showed statistically significant improvements over preoperative levels, and both groups were able to attain favorable clinical outcomes.\u003c/p\u003e \u003cp\u003eAccording to studies\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, there is a larger chance of difficulties in the early stages of surgery (the first 50 cases), and perioperative issues of UBE surgery tend to emerge during the first learning and surgical progression phases. Incomplete decompression, nerve damage, dural tears, epidural hematomas, and other common complications have been documented in earlier research\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.The two groups in this study did not experience any of the aforementioned problems. However, because endoscopic equipment is highly specialized, difficulties were common in the early stages of endoscope learning.\u003c/p\u003e \u003cp\u003eThere are certain restrictions on this study: First of all, the study is retrospective and has little supporting data. Furthermore, because of the limited sample size and short follow-up period, a larger sample should be used for future long-term follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile UE and UBE can both effectively cure lumbar spinal stenosis in the short term, UBE has a greater ability to preserve zygapophysial joint and has a stronger decompression effect on imaging test results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the doctors who contributed to this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and study design\u0026mdash;\u0026nbsp;Meng Xiangyu;data acquisition; data analysis and interpretation\u0026mdash;Gaojiang ;drafting the article\u0026mdash; Gaojiang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe experimental protocol was developed according to the Declaration of Helsinki ethical guidelines and approved by the Ethics Committee of\u0026nbsp;the Sixth Affiliated Hospital of Xinjiang Medical University. Written informed consent was obtained from the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLafian AM, Torralba KD. Lumbar Spinal Stenosis in Older Adults. Rheum Dis Clin North Am. 2018;44(3):501\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1016/j.rdc.2018.03.008\u003c/span\u003e\u003cspan address=\"https://doi:10.1016/j.rdc.2018.03.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. 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PMID: 26722954.\u003c/span\u003e\u003c/li\u003e\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":"[email protected]","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":"Lumbar spinal stenosis, unilateral biportal endoscopy, uniportal endoscopy","lastPublishedDoi":"10.21203/rs.3.rs-4193917/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4193917/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eTo assess the clinical effectiveness of unilateral biportal endoscopy (UBE) \u0026nbsp;and \u0026nbsp;uniportal endoscopy (UE) in the management of lumbar spinal stenosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u0026nbsp;\u003c/strong\u003eRetrospective analysis was done on the clinical records of 61 patients with lumbar spinal stenosis treated with UBE or UE in the minimally invasive spine surgery department of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2023 and January 2024. The patients' average age was 66.4±12.5, and they included 24 males and 37 females. Using various surgical techniques, the patients were split into two groups: the UE group (33 cases) and the UBE group (28 cases). In order to assess the treatment scores, data on the two groups' operational times, intraoperative blood loss, visual analogue scales (VAS), and 0swestry Disability Index (0DI) were gathered and compared. The area of the dural sac and the angle of facet joint resection were determined based on preoperative and postoperative MRI and CT scans, and the problems were noted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eEvery patient had a successful surgical procedure.The intraoperative blood loss in the UBE group was 79.8±17.2ml, and the operative time was 68.7±9.8min.The group's UE was 71.5±10.8min and 73.5±21.7ml, respectively. There was no statistically significant difference between the groups (p\u0026gt;0.05).The two groups' post-operative VAS and ODI scores were lower than their pre-operative scores and exhibited a persistent downward trend. No statistically significant differences were found between the groups (p\u0026gt;0.05) in the variance analysis of the repeated measurement design.At the most recent follow-up, the rate of good and good showed no statistical significance (P\u0026gt;0.05).The dural sac area was (103.25±35.16) mm2 in the UE group and (126.73±42.74) mm2 in the UBE group (P\u0026lt;0.02).In the UBE group, the angle of lateral facet arthrotomy was 77.92°±12.17°, but in the UE group, it was 95.48°±11.98° (P\u0026lt;0.000).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u0026nbsp;\u003c/strong\u003eBoth UBE and UE have good short-term clinical efficacy in treating lumbar spinal stenosis; however, UBE has a better imaging decompression effect and can better preserve zygapophysial joint.\u003c/p\u003e","manuscriptTitle":"To assess the clinical effectiveness of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) in the management of lumbar spinal stenosis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-09 21:13:38","doi":"10.21203/rs.3.rs-4193917/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"3aceb62e-9b9c-4aa9-9e11-55ab6c4a02b1","owner":[],"postedDate":"April 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-16T14:28:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-09 21:13:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4193917","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4193917","identity":"rs-4193917","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}