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World Neurosurg. 2019 May 9. pii: S1878-8750(19)31247-1. doi: 10.1016/j.wneu.2019.04.240. [Epub ahead of print]

Is the Use of a Unilateral Biportal Endoscopic Approach Associated with Rapid Recovery After Lumbar Decompressive Laminectomy? A Preliminary Analysis of a Prospective Randomized Controlled Trial.

Author information

1
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
2
Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea.
3
Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
4
Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: highcervical@gmail.com.

Abstract

OBJECTIVE:

The purpose of this study was to assess the immediate postoperative clinical outcomes and perform a preliminary analysis of the effectiveness of biportal endoscopic approaches to lumbar decompressive laminectomy in the treatment of lumbar spinal stenosis.

METHODS:

All participants (64 patients) were randomly assigned in a 1:1 ratio to either the biportal endoscopic lumbar decompressive laminectomy (BE-D) group or the mini-open microscopic lumbar decompressive laminectomy (MI-D) group. Early postoperative outcomes were evaluated using clinical and surgical technique-related outcomes. The visual analog scale (VAS) pain score was measured at 6 time points after surgery (at 4, 8, 16, 24, and 48 hours and 2 weeks). Surgical technique-related outcomes were also analyzed.

RESULTS:

There were no significant differences in the preoperative demographics between the 2 groups. The VAS pain score from 8 to 48 hours (P < 0.05) was significantly lower in the BE-D group than in the MI-D group. Moreover, the total amount of fentanyl usage was higher in the MI-D group than in the BE-D group after surgery (P = 0.026). The length of hospital stay was lower in the BE-D group than in the MI-D group (P = 0.048). The operative time and creatinine phosphokinase level were not significantly different between the groups (P >0.05). Postoperative drainage was significantly higher in the BE-D group than in the MI-D group.

CONCLUSIONS:

BE-D was associated with rapid pain recovery, low fentanyl usage, and early discharge after surgery, but its other benefits have not yet been shown.

KEYWORDS:

Biportal endoscopic spine surgery; Degenerative spine; Lumbar spinal stenosis; Unilateral laminectomy and bilateral decompression; Visual analog scale

PMID:
31077891
DOI:
10.1016/j.wneu.2019.04.240

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