[The clinical efficacy of unilateral biportal endoscopy contralateral inclinatory approach in the treatment of lumbar foraminal stenosis].

Objective

To evaluate the clinical efficacy of unilateral biportal endoscopy contralateral inclinatory approach (UBE-CIA) in the treatment of lumbar foraminal stenosis.

Methods

A retrospective case series study was conducted on 32 patients with lumbar foraminal stenosis who underwent UBE-CIA at Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University between March 2021 and December 2024. There were 14 males and 18 females, with an age of (54.7±12.3) years (range:27 to 77 years). In terms of clinical indicators, the visual analogue scale (VAS) for pain and the Oswestry disability index (ODI) were recorded preoperatively,postoperatively, and at final follow-up. The modified MacNab criteria were used to evaluate clinical efficacy. Regarding radiological indicators, the changes in the foraminal area and facet joint area were measured preoperatively and postoperatively. Repeated measures analysis of variance was used for comparing repeated measurement data, and the Student-Newman-Keuls test was used for pairwise comparisons. Paired sample t-test was used for comparing radiological data.

Results

All 32 patients underwent operations successfully with an operative time of (91.9±33.4) min (range:43 to 172 min) and postoperative hospital stay of (5.8±1.7)d (range:2 to 10 d). All patients were followed up for (17.1±4.6) months (range:7 to 30 months). The VAS score for lower extremity pain in patients before surgery was 7.2±1.0, which decreased to 2.0±0.8 one week after surgery and further to 0.8±0.5 at the last follow-up (F=406.822, P<0.01); the VAS score for low back pain before surgery was 4.5±1.2, which dropped to 1.8±0.9 one week after surgery and further to 0.7±0.5 at the last follow-up (F=175.579, P<0.01); the ODI before surgery was (69.0±8.7)%, which decreased to (25.9±6.0)% one week after surgery and further to (10.3±2.5)% at the last follow-up (F=662.586, P<0.01). All differences were statistically significant. The excellent and good rate according to the modified MacNab criteria was 93.8% (30/32). The foraminal area increased from (61.4±14.6) mm² to (108.4±16.9) mm², with a statistically significant difference (t=-18.190, P<0.01). The facet joint preservation rate was (85.8±3.9)%.

Conclusions

UBE-CIA provides excellent clinical efficacy for lumbar foraminal stenosis. It effectively relieves lower limb and back pain, significantly improves functional disability, and achieves effective decompression of the exiting nerve root, providing an effective treatment option for complex foraminal stenosis diseases.