6. Comparative study for complications of unilateral biportal endoscopic spine surgery between using and not using Kerrison punches (no-punch technique)

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100700

Jwo-Luen Pao MD

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引用次数: 0

Abstract

BACKGROUND CONTEXT

Unilateral biportal endoscopic (UBE) spine surgery has gained worldwide popularity and extended indications in recent years. We have proposed the “no-punch technique” to effectively reduce the complication rate in decompression surgery for degenerative lumbar spinal stenosis by not using the Kerrison punch at all.

PURPOSE

To evaluate the effectiveness of the “no-punch technique” in reducing the complication rate in the UBE surgeries for the extended surgical indications of degenerative spinal disorders.

STUDY DESIGN/SETTING

A retrospective comparative study of two cohorts receiving UBE surgeries of different surgical techniques.

PATIENT SAMPLE

This study included 914 consecutive patients with various degenerative spine disorders who received UBE surgery between October 2018 and July 2023. These patients were divided into Group A, which included 660 patients (830 segments) receiving UBE surgeries with the Kerrison punches, and Group B, which included 254 patients (330 segments) receiving UBE surgeries with the “no-punch technique.”

OUTCOME MEASURES

N/A

METHODS

The “no-punch technique” uses electric high-speed drills and chisels of different curve angles as the principal surgical instruments to replace the Kerrison punches. The decompression was performed by resecting the peripheral bony margin and then removing the ligamentum flavum as a whole piece or pieces. The operation notes and medical charts were reviewed to evaluate the occurrence of surgical complications and their distribution in subcategories of surgical procedures.

RESULTS

There were 63 surgical complications (58 in Group A and 5 in Group B), including accidental dural tears, nerve root injuries, incomplete decompression, epidural hematoma, and broken instruments were identified. The overall complication rate and the incidence of dural tears were significantly reduced in Group B (8.8% vs 2.0% and 3.9% vs 0). The incidence of neural injuries, including dural tears and nerve root injuries, was also significantly reduced in Group B (5.3% vs 0.4%), especially in the subcategories of decompression surgeries (5.0% vs 0.8%) and revision surgeries (9.9% vs. 0). The incidence of incomplete decompression and epidural hematoma and distribution of such complications in the subcategories of surgical procedures did not differ significantly between Group A and B.

CONCLUSIONS

The “no-punch technique” effectively reduces the overall complication rate and the incidence of neural injuries in UBE surgeries. This modification of the surgical technique makes UBE surgery a safer endoscopic procedure with guaranteed treatment outcomes.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

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6. 单侧双门静脉内窥镜脊柱手术中使用与不使用Kerrison冲床（无冲床技术）并发症的比较研究

背景：近年来，双侧门静脉内窥镜脊柱手术在世界范围内得到了广泛的应用。为了有效降低退行性腰椎管狭窄减压手术的并发症发生率，我们提出了“无打孔技术”，完全不使用Kerrison打孔器。目的评价“无打孔技术”在腰椎退行性疾病扩大手术指征中降低手术并发症发生率的效果。研究设计/设置对接受不同手术技术的UBE手术的两个队列进行回顾性比较研究。患者样本：该研究包括914名连续的患有各种退行性脊柱疾病的患者，他们在2018年10月至2023年7月期间接受了UBE手术。这些患者被分为A组，其中包括660名患者（830个节段）使用Kerrison冲床进行UBE手术，B组包括254名患者（330个节段）使用“无冲床技术”进行UBE手术。结果测量/方法“无冲孔技术”采用不同曲线角度的高速电钻和凿子作为主要手术器械来代替Kerrison冲孔。减压是通过切除周围骨缘，然后将黄韧带作为一个或多个整体切除来进行的。回顾了手术记录和病历，以评估手术并发症的发生及其在外科手术亚类中的分布。结果共发现63例手术并发症（A组58例，B组5例），包括意外硬膜撕裂、神经根损伤、减压不完全、硬膜外血肿、器械断裂等。B组总并发症发生率和硬膜撕裂发生率明显降低（8.8% vs 2.0%, 3.9% vs 0）。神经损伤的发生率，包括硬脑膜撕裂和神经根损伤，在B组也显著降低（5.3%比0.4%），特别是在减压手术亚类别（5.0%比0.8%）和翻修手术（9.9%比0）。A、b组不完全减压和硬膜外血肿的发生率及其在手术亚类中的分布无显著性差异。结论“无打孔技术”有效降低了UBE手术的总并发症发生率和神经损伤发生率。这种手术技术的改进使UBE手术成为一种更安全的内窥镜手术，保证了治疗结果。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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