关键词: 腰椎管狭窄症, 内镜技术, 单侧双通道内镜技术, 微创性, Meta分析

Abstract:

Objective To provide instructions to clinical decision-making by comparing the efficacy of unilateral biportal endoscopic(UBE) and microendoscopic discectomy (MED) in treating degenerative lumbar spinal stenosis(LSS). Methods Chinese and English study papers on UBE and MED for degenerative LSS were respectively searched in PubMed, Web of Science,Cochrane Library,Embase,Wanfang Database,CNKI,VIP,China Biologicl Medicine (CBM) and other databases, and controlled clinical studies on UBE and MED therapies with the search duration starting from the setup of databases to March 2020 were collected. The study documents were subject to the screening, quality evaluation and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 and Stata15.1 software were applied for meta-analysis on the extracted data. The operation duration, blood loss, visual analogue scake (VAS) score of back and leg pain in the last follow-up, disability index (ODI), complication rates, postoperative dural distension, and intraoperative blood loss were included as comparator. Results Finally, 10 study papers (3 randomized controlled trials (RCTs) and 7 non-randomized controlled trials (N-RCTs)) involving a total of 880 patients were included, and 407 UBE cases and 473 MED cases were noted. The meta-analysis results showed that differences in the degree of dura extension, operation duration, intra-operative blood loss and ODI between groups weren't statistically significant. Compared with MED group, the lower VAS scores of the back pain in the last follow-up [MD=-0.18,95%CI(-0.31,-0.05),P=0.006] and leg pain [MD=-0.15,95%CI(-0.27,-0.04),P=0.008] as well as higher incidence rate of complications[OR=0.54,95%CI(0.31,0.94),P=0.03] were noted in UBE group. Conclusion Both UBE and MED are both effective treatments of degenerative LSS, MED is found to be superior to UBE in reducing the complications, while UBE is advantageous in improving VAS scores of the post-operative back pain, and overall consideration should be taken in the selection on surgery program.

Key words: lumbar spinal stenosis, endoscopic technology, unilateral biportal endoscopic, minimally invasive, Meta-analysis