Unilateral biportal endoscopy for minimally invasive spinal fusion: Advancements in biomaterials and clinical outcome optimization.

IF 2.3 Q2 ORTHOPEDICS
Song Fu, Li-Chuan Hou, Xiao-Ling Huang, Wei Zhao, Feng-Ming Wang, Ya-Nan Wang
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Abstract

Lumbar interbody fusion is essential for treating degenerative lumbar diseases. The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery, including endoscopic techniques such as unilateral biportal endoscopy (UBE). Leveraging arthroscopic principles, UBE offers superior visualization and flexibility and expands from decompression to fusion (UBE fusion). However, achieving robust UBE fusion presents challenges, such as suboptimal arthrodesis rates and implant-related complications, requiring more than surgical skill alone. Optimizing UBE fusion critically depends on the effective integration of advanced biomaterials with the surgical technique. This minireview assessed recent advances in UBE, focusing on the development of novel biomaterials, such as functionalized porous, expandable, or double-cage designs, to improve bone regeneration outcomes. These advancements address challenges, like washout of bone graft material and biologics, and utilize growth factors, such as recombinant human bone morphogenetic proteins, while exploring pathway modulation to improve outcomes. We also evaluated clinical optimization strategies involving technical refinements, fluid and hemostasis control, key complication mitigation especially concerning dural tears and hematomas, and technologies such as navigation and robotics. While UBE shows promise particularly for early recovery, its long-term success hinges on these biotechnological advancements. High-quality evidence, especially from randomized controlled trials and long-term studies, is needed to validate integrated strategies and define the optimal role of UBE fusion.

Abstract Image

单侧双门静脉内窥镜微创脊柱融合术:生物材料和临床结果优化的进展。
腰椎椎间融合术是治疗退行性腰椎疾病的必要手段。开放手术的缺点导致了微创脊柱手术的发展,包括内窥镜技术,如单侧双门静脉内窥镜(UBE)。利用关节镜原理,UBE提供了卓越的可视化和灵活性,并从减压扩展到融合(UBE融合)。然而,实现强健的UBE融合存在挑战,如关节融合率不理想和植入物相关并发症,需要的不仅仅是手术技巧。优化UBE融合关键取决于先进生物材料与手术技术的有效结合。这篇微型综述评估了UBE的最新进展,重点是新型生物材料的发展,如功能化多孔、可膨胀或双笼设计,以改善骨再生结果。这些进展解决了骨移植材料和生物制剂的冲洗等挑战,并利用了重组人骨形态发生蛋白等生长因子,同时探索了途径调节以改善结果。我们还评估了临床优化策略,包括技术改进、液体和止血控制、关键并发症缓解(特别是硬脑膜撕裂和血肿)以及导航和机器人等技术。虽然UBE尤其在早期康复方面表现出希望,但它的长期成功取决于这些生物技术的进步。需要高质量的证据,特别是来自随机对照试验和长期研究的证据,来验证综合策略并确定UBE融合的最佳作用。
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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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
814
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