Clinical analysis of percutaneous endoscopic unilateral laminotomy for bilateral decompression for single segment degenerative lumbar spinal stenosis: a systematic review and single-arm meta-analysis.
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Abstract
Background: In recent years, percutaneous endoscopic unilateral laminotomy for bilateral decompression (PE-ULBD) has been used to treat degenerative lumbar spinal stenosis (LSS) and has achieved good results. Some researchers have conducted statistical analysies and evaluated the efficacy of this technology. In this systematic review and single-arm meta-analysis, the effectiveness of PE-ULBD as a surgical method for treating single segment LSS was evaluated from the perspective of evidence-based medicine. The aim was to provide a scientific basis for the clinical application of this technology in LSS treatment.
Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 396 studies published before May 29, 2024 were collected from the PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure(CNKI), and WanFang databases.
Results: Eight retrospective studies were found with 287 patients who met the inclusion criteria set for the systematic review and single-arm meta-analysis. We used the methodological index for non-randomized studies (MINORS) scale to evaluate the quality of the included studies. The results indicated that significant difference in VAS scores between preoperative and postoperative back and leg pain and the difference between the control results recorded before and after the two types of pain scores was statistically significant (P < 0.05). In addition, the difference between the Oswestry Disability Index (ODI) scores recorded in the different groups before and after surgery was statistically significant (P < 0.05). Although the results showed high heterogeneity, a sensitivity analysis showed that there was no significant deviation in other results except for the VAS and ODI score for leg pain in the preoperative and three-month postoperative groups. Secondary clinical outcomes included an average operational time of 97.15 min (95% CI = 82.83, 111.47), an average intraoperative bleeding volume of 26.52 ml (95% CI = 10.51, 42.52), an average hospital stay of 4.16 days (95% CI = 2.96, 5.35), and an incidence of complications of 0.10 (95% CI = 0.06, 0.14).
Conclusion: Our results indicate that the PE-ULBD technique has significant short and long-term clinical efficacy for the treatment of single-segment LSS and is worthy of clinical application and promotion.
背景：近年来，经皮内窥镜单侧椎板切开术用于双侧减压（PE-ULBD）治疗退行性腰椎管狭窄症（LSS）取得了良好的效果。一些研究人员进行了统计分析，并对该技术的功效进行了评估。本系统综述和单臂荟萃分析从循证医学的角度评价PE-ULBD作为一种手术方法治疗单节段LSS的有效性。旨在为该技术在LSS治疗中的临床应用提供科学依据。方法：按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。从PubMed、Web of Science、Embase、Cochrane Library、中国知网（CNKI）和万方数据库中收集2024年5月29日之前发表的研究共396篇。结果：8项回顾性研究共纳入287例患者，符合系统评价和单臂荟萃分析的纳入标准。我们使用非随机研究方法学指数（minor）量表来评价纳入研究的质量。结果显示，腰、腿疼痛术前、术后VAS评分差异有统计学意义，两种疼痛评分前后对照结果差异有统计学意义（P P）。结论：PE-ULBD技术治疗单节段LSS短期和长期临床疗效显著，值得临床应用和推广。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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