Annali italiani di chirurgia · 2025
Clinical Efficacy and Risk Factors for Complications of Unilateral Biportal Endoscopy Treatment in Complex Spinal Stenosis: A Retrospective Study.
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Niu Yuanqing, Chang Hengrui, Xu Jiaxin
Аннотация
AIM: This study aimed to evaluate the clinical efficacy of unilateral biportal endoscopy (UBE) technology in patients with complex spinal stenosis and to identify factors associated with postoperative complications to optimize individualized treatment strategies.
METHODS: This single-center retrospective study included 146 patients with complex spinal stenosis, characterized by multi-segmental involvement and/or ligamentum flavum calcification, who underwent UBE between May 2020 and March 2023. Eligible patients had complete clinical and imaging data and a minimum follow-up of 6 months. Surgical variables (operative time, intraoperative blood loss, and length of hospital stay), perioperative information, and early mobilization protocols were collected. Primary outcomes included pain intensity (visual analog scale (VAS)), functional disability (Oswestry Disability Index (ODI)), and neurological recovery (Japanese Orthopaedic Association (JOA)). Secondary outcomes involved complication rates, recurrence, and patient satisfaction. Pre- and postoperative differences were assessed using paired t-tests, and multivariate logistic regression was performed to identify independent risk factors for postoperative complications.
RESULTS: UBE significantly improved clinical symptoms, with VAS scores decreasing from 7.5 ± 0.9 preoperatively to 2.5 ± 0.8 postoperatively (p < 0.001), ODI scores decreasing from 55.8 ± 8.3% to 19.6 ± 6.4% (p < 0.001), and JOA scores increasing from 8.7 ± 1.9 to 19.8 ± 3.1 (p < 0.001). Imaging evaluations showed a significant increase in spinal canal area (p < 0.001). The overall complication rate was 19.9% (29 cases), with ligamentum flavum calcification identified as an independent risk factor (odds ratio (OR) = 3.414, 95% confidence interval (CI): 1.383-8.432, p = 0.008). The satisfaction score of 88.4% of patients is ≥4 points.
CONCLUSIONS: UBE technology effectively improves clinical symptoms and imaging outcomes for managing complex spinal stenosis, with low complication and recurrence rates. However, the presence of ligamentum flavum calcification is a critical risk factor for complications, highlighting the need for tailored preoperative planning to optimize surgical outcomes and reduce risks.
METHODS: This single-center retrospective study included 146 patients with complex spinal stenosis, characterized by multi-segmental involvement and/or ligamentum flavum calcification, who underwent UBE between May 2020 and March 2023. Eligible patients had complete clinical and imaging data and a minimum follow-up of 6 months. Surgical variables (operative time, intraoperative blood loss, and length of hospital stay), perioperative information, and early mobilization protocols were collected. Primary outcomes included pain intensity (visual analog scale (VAS)), functional disability (Oswestry Disability Index (ODI)), and neurological recovery (Japanese Orthopaedic Association (JOA)). Secondary outcomes involved complication rates, recurrence, and patient satisfaction. Pre- and postoperative differences were assessed using paired t-tests, and multivariate logistic regression was performed to identify independent risk factors for postoperative complications.
RESULTS: UBE significantly improved clinical symptoms, with VAS scores decreasing from 7.5 ± 0.9 preoperatively to 2.5 ± 0.8 postoperatively (p < 0.001), ODI scores decreasing from 55.8 ± 8.3% to 19.6 ± 6.4% (p < 0.001), and JOA scores increasing from 8.7 ± 1.9 to 19.8 ± 3.1 (p < 0.001). Imaging evaluations showed a significant increase in spinal canal area (p < 0.001). The overall complication rate was 19.9% (29 cases), with ligamentum flavum calcification identified as an independent risk factor (odds ratio (OR) = 3.414, 95% confidence interval (CI): 1.383-8.432, p = 0.008). The satisfaction score of 88.4% of patients is ≥4 points.
CONCLUSIONS: UBE technology effectively improves clinical symptoms and imaging outcomes for managing complex spinal stenosis, with low complication and recurrence rates. However, the presence of ligamentum flavum calcification is a critical risk factor for complications, highlighting the need for tailored preoperative planning to optimize surgical outcomes and reduce risks.