Muhadasi Tuerxunyiming , Xingang Wang , Shihao Zhou , Xiaowan Xu , Jianpeng Zheng , Mengru Guan , Qiuyun Lin , Yamin Li
{"title":"两种内镜腰椎融合技术治疗退行性疾病的手术侵入性、隐性失血和结果:一项比较研究。","authors":"Muhadasi Tuerxunyiming , Xingang Wang , Shihao Zhou , Xiaowan Xu , Jianpeng Zheng , Mengru Guan , Qiuyun Lin , Yamin Li","doi":"10.1016/j.wneu.2025.124208","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The rapid advancement of spinal endoscopic techniques has underscored the need for comparative evaluations of various surgical approaches. This study compares unilateral biportal endoscopic lumbar interbody fusion (ULIF) and full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) in the treatment of lumbar degenerative diseases, with a focus on surgical invasiveness, hidden blood loss, and clinical outcomes.</div></div><div><h3>Methods</h3><div>A total of 120 patients diagnosed with lumbar degenerative diseases were enrolled between January 2021 and January 2024. Of these, 63 patients underwent ULIF and 57 received Endo-PLIF. Perioperative indicators were recorded, including operative time, hospital stay, incision length, intraoperative blood loss, and changes in intervertebral disc and foraminal height. Clinical outcomes were assessed using visual analog scale (VAS) scores for back and leg pain, the Oswestry Disability Index, and the modified Macnab criteria at the final follow-up. Assessments were conducted preoperatively and at 3 days, 3 months, 6 months, and 12 months postoperatively. Fusion rates and complication incidences were also documented. Muscle injury was quantified by measuring serum levels of creatine kinase (CK) and C-reactive protein (CRP) preoperatively and on postoperative days 1, 3, and 5. Descriptive statistics and multiple comparison tests were applied to assess differences in clinical indicators between the 2 surgical groups. The VAS score served as the primary clinical outcome. Longitudinal data were analyzed using a generalized linear mixed model to evaluate intergroup differences over time.</div></div><div><h3>Results</h3><div>Baseline demographic and surgical data were comparable between the 2 groups. The CRP and CK levels in the Endo-PLIF group were generally lower than those in the ULIF group, particularly on postoperative day 3 for CRP and on postoperative day 1 for CK. Compared to the ULIF group, the Endo-PLIF group exhibited significantly reduced total blood loss, postoperative blood loss, and hidden blood loss. No significant difference was observed in postoperative hospital stay duration between the groups. Both groups showed improvements in VAS pain scores and Oswestry Disability Index. A significant reduction in VAS back pain was observed on the third day after ULIF, while leg pain improved significantly at 3 days and 3 months postsurgery. At the final follow-up, no further differences in clinical outcomes were observed between the 2 groups.</div></div><div><h3>Conclusions</h3><div>Both surgical methods resulted in significant relief of back pain and functional improvement. Although ULIF showed a distinct advantage in early postoperative pain control and functional recovery, outcomes for both techniques became comparable during long-term follow-up. However, Endo-PLIF exhibited a significant advantage in terms of reduced surgical trauma and blood loss. Overall, both methods represent viable treatment options with acceptable safety profiles. The choice of approach should be tailored to the individual patient’s condition, considering the trade-offs between early recovery and surgical invasiveness.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"200 ","pages":"Article 124208"},"PeriodicalIF":2.1000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical Invasiveness, Hidden Blood Loss, and Outcomes of 2 Endoscopic Lumbar Fusion Techniques for Degenerative Disease: A Comparative Study\",\"authors\":\"Muhadasi Tuerxunyiming , Xingang Wang , Shihao Zhou , Xiaowan Xu , Jianpeng Zheng , Mengru Guan , Qiuyun Lin , Yamin Li\",\"doi\":\"10.1016/j.wneu.2025.124208\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The rapid advancement of spinal endoscopic techniques has underscored the need for comparative evaluations of various surgical approaches. This study compares unilateral biportal endoscopic lumbar interbody fusion (ULIF) and full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) in the treatment of lumbar degenerative diseases, with a focus on surgical invasiveness, hidden blood loss, and clinical outcomes.</div></div><div><h3>Methods</h3><div>A total of 120 patients diagnosed with lumbar degenerative diseases were enrolled between January 2021 and January 2024. Of these, 63 patients underwent ULIF and 57 received Endo-PLIF. Perioperative indicators were recorded, including operative time, hospital stay, incision length, intraoperative blood loss, and changes in intervertebral disc and foraminal height. Clinical outcomes were assessed using visual analog scale (VAS) scores for back and leg pain, the Oswestry Disability Index, and the modified Macnab criteria at the final follow-up. Assessments were conducted preoperatively and at 3 days, 3 months, 6 months, and 12 months postoperatively. Fusion rates and complication incidences were also documented. Muscle injury was quantified by measuring serum levels of creatine kinase (CK) and C-reactive protein (CRP) preoperatively and on postoperative days 1, 3, and 5. Descriptive statistics and multiple comparison tests were applied to assess differences in clinical indicators between the 2 surgical groups. The VAS score served as the primary clinical outcome. Longitudinal data were analyzed using a generalized linear mixed model to evaluate intergroup differences over time.</div></div><div><h3>Results</h3><div>Baseline demographic and surgical data were comparable between the 2 groups. The CRP and CK levels in the Endo-PLIF group were generally lower than those in the ULIF group, particularly on postoperative day 3 for CRP and on postoperative day 1 for CK. Compared to the ULIF group, the Endo-PLIF group exhibited significantly reduced total blood loss, postoperative blood loss, and hidden blood loss. No significant difference was observed in postoperative hospital stay duration between the groups. Both groups showed improvements in VAS pain scores and Oswestry Disability Index. A significant reduction in VAS back pain was observed on the third day after ULIF, while leg pain improved significantly at 3 days and 3 months postsurgery. At the final follow-up, no further differences in clinical outcomes were observed between the 2 groups.</div></div><div><h3>Conclusions</h3><div>Both surgical methods resulted in significant relief of back pain and functional improvement. Although ULIF showed a distinct advantage in early postoperative pain control and functional recovery, outcomes for both techniques became comparable during long-term follow-up. However, Endo-PLIF exhibited a significant advantage in terms of reduced surgical trauma and blood loss. Overall, both methods represent viable treatment options with acceptable safety profiles. The choice of approach should be tailored to the individual patient’s condition, considering the trade-offs between early recovery and surgical invasiveness.</div></div>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":\"200 \",\"pages\":\"Article 124208\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878875025005649\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878875025005649","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Surgical Invasiveness, Hidden Blood Loss, and Outcomes of 2 Endoscopic Lumbar Fusion Techniques for Degenerative Disease: A Comparative Study
Background
The rapid advancement of spinal endoscopic techniques has underscored the need for comparative evaluations of various surgical approaches. This study compares unilateral biportal endoscopic lumbar interbody fusion (ULIF) and full-endoscopic posterior lumbar interbody fusion (Endo-PLIF) in the treatment of lumbar degenerative diseases, with a focus on surgical invasiveness, hidden blood loss, and clinical outcomes.
Methods
A total of 120 patients diagnosed with lumbar degenerative diseases were enrolled between January 2021 and January 2024. Of these, 63 patients underwent ULIF and 57 received Endo-PLIF. Perioperative indicators were recorded, including operative time, hospital stay, incision length, intraoperative blood loss, and changes in intervertebral disc and foraminal height. Clinical outcomes were assessed using visual analog scale (VAS) scores for back and leg pain, the Oswestry Disability Index, and the modified Macnab criteria at the final follow-up. Assessments were conducted preoperatively and at 3 days, 3 months, 6 months, and 12 months postoperatively. Fusion rates and complication incidences were also documented. Muscle injury was quantified by measuring serum levels of creatine kinase (CK) and C-reactive protein (CRP) preoperatively and on postoperative days 1, 3, and 5. Descriptive statistics and multiple comparison tests were applied to assess differences in clinical indicators between the 2 surgical groups. The VAS score served as the primary clinical outcome. Longitudinal data were analyzed using a generalized linear mixed model to evaluate intergroup differences over time.
Results
Baseline demographic and surgical data were comparable between the 2 groups. The CRP and CK levels in the Endo-PLIF group were generally lower than those in the ULIF group, particularly on postoperative day 3 for CRP and on postoperative day 1 for CK. Compared to the ULIF group, the Endo-PLIF group exhibited significantly reduced total blood loss, postoperative blood loss, and hidden blood loss. No significant difference was observed in postoperative hospital stay duration between the groups. Both groups showed improvements in VAS pain scores and Oswestry Disability Index. A significant reduction in VAS back pain was observed on the third day after ULIF, while leg pain improved significantly at 3 days and 3 months postsurgery. At the final follow-up, no further differences in clinical outcomes were observed between the 2 groups.
Conclusions
Both surgical methods resulted in significant relief of back pain and functional improvement. Although ULIF showed a distinct advantage in early postoperative pain control and functional recovery, outcomes for both techniques became comparable during long-term follow-up. However, Endo-PLIF exhibited a significant advantage in terms of reduced surgical trauma and blood loss. Overall, both methods represent viable treatment options with acceptable safety profiles. The choice of approach should be tailored to the individual patient’s condition, considering the trade-offs between early recovery and surgical invasiveness.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS