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Abstract Objective To investigate the efficacy and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) for lumbar spinal stenosis (LSS).Methods The data of 63 patients with LSS retrospectively analyzed，who underwent UBE-LIF in the Department of Orthopaedics in The First Affiliated Hospital of Xinjiang Medical University from March 2021 to March 2022.24 males and 39 females were included.The age ranged from 45 to 75 years，with an average of (61.17±7.88) years.The operation time，intraoperative blood loss，postoperative drainage volume，ambulation time，postoperative hospital stay and complications were recorded.The clinical efficacy was evaluated by visual analog scale (VAS) scores of low back and leg，Japanese orthopaedic association (JOA) score，Oswestry disability index (ODI)，and modified Macnab criteria.The radiological outcomes were evaluated by X-ray or CT 6 months after the operation and the final follow-up，and the fusion of the operated segments was assessed using Bridwell grading criteria.Results The procedures of 63 patients were completed successfully.The operation time was 100 to 195 minutes，with an average of (139.37±20.88) minutes.The intraoperative blood loss was 85 to 190 mL，with an average of (124.52±21.58) mL.Postoperative drainage volume was 15 to 65 mL，with an average of (35.48±10.34) mL.The ambulation time was 1 to 3 days，with an average of (1.70±0.59) days.Postoperative hospital stay was 3 to 6 days，with an average of (4.53±0.59) days.Postoperative follow-up 12 to 20 months，with an average of (15.20±2.23) months.A total of 8 complications occurred，with an incidence of 12.69%.The VAS scores of low back and leg，JOA score，and ODI were significantly improved compared to those before the operation at each postoperative follow-up time point，and the differences were statistically significant (P＜0.05).The modified Macnab criteria evaluation at the final follow-up showed that the outcomes were excellent in 48 cases (76.19%)，good in 8 cases (12.70%)，fair in 7 cases (11.11%)，with a rate of excellent and good was 88.89%.At the 6 month postoperative followup，15 cases (23.80%) were classified as Bridwell grade Ⅰ，20 cases (31.75%) as grade Ⅱ，24 cases (38.10%) as grade Ⅲ，4 cases (6.35%) as grade Ⅳ，respectively.At the final followup，58 cases (92.06%) were classified as Bridwell grade Ⅰ，5 cases (7.94%) as grade Ⅱ，respectively. Conclusion UBE-LIF is a safe and effective minimally invasive fusion procedure for the treatment of LSS with excellent efficacy and radiological outcomes，which can provide new treatment options for patients with LSS.
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Corresponding Authors:
Wang Chong
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［1］Lee SY，Kim TH，Oh JK，et al.Lumbar stenosis：A recent update by review of literature［J］.Asian Spine J，2015，9(5)：818-828.
［2］Weinstein JN，Tosteson TD，Lurie JD，et al.Surgical versus nonsurgical therapy for lumbar spinal stenosis［J］.N Engl J Med，2008，358(8)：794-810.
［3］Hwa Eum J，Hwa Heo D，Son SK，et al.Percutaneous biportal endoscopic decompression for lumbar spinal stenosis：A technical note and preliminary clinical results［J］.J Neurosurg Spine，2016，24(4)：602-607.
［4］Caputy AJ，Spence CA，Bejjani GK，et al.The role of spinal fusion in surgery for lumbar spinal stenosis：A review［J］.Neurosurg Focus，1997，3(2)：e3.
［5］Choi JM，Choi MK，Kim SB.Perioperative results and complications after posterior lumbar interbody fusion for spinal stenosis in geriatric patients over than 70 years old［J］.J Korean Neurosurg Soc，2017，60(6)：684-690.
［6］Hu ZJ，Fang XQ，Zhou ZJ，et al.Effect and possible mechanism of musclesplitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery［J］.J Bone Joint Surg (Am)，2013，95(24)：e192(1-9).
［7］Hartmann F，Janssen C，B-hm S，et al.Biomechanical effect of graded minimalinvasive decompression procedures on lumbar spinal stability［J］.Arch Orthop Trauma Surg，2012，132(9)：1233-1239.
［8］Heo DH，Son SK，Eum JH，et al.Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique：Technical note and preliminary clinical results［J］.Neurosurg Focus，2017，43(2)：E8.
［9］Kim JE，Yoo HS，Choi DJ，et al.Learning curve and clinical outcome of biportal endoscopicassisted lumbar interbody fusion［J］.Biomed Res Int，2020(2020)：881543.
［10］余可谊，孙权，仉建国，等.内镜下椎弓根螺钉置入结合双通道内镜下椎间融合、减压治疗腰椎管狭窄并腰椎滑脱、不稳的早期临床效果［J］.中华医学杂志，2022，102(41)：3288-3294.
［11］吕剑伟，朱斌，钟华璋，等.单侧双通道内镜下经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的早期疗效分析［J］.中国脊柱脊髓杂志，2022，32(7)：586-594.
［12］孙兵，车晓明.视觉模拟评分法(VAS)［J］.中华神经外科杂志，2012，28(6)：645.
［13］孙兵，车晓明.日本骨科协会评估治疗(JOA评分)［J］.中华神经外科杂志，2013，29(9)：969.
［14］许斌，王与荣，赵建宁，等.ODI在腰椎间盘突出症手术疗效评价中的应用［J］.颈腰痛杂志，2004，25(1)：31-34.
［15］Macnab I.Negative disc exploration：An analysis of the causes of nerveroot involvement in sixty-eight patients［J］.J Bone Joint Surg (Am)，1971，53(5)：891-903.
［16］Bridwell KH，Lenke LG，McEnery KW，et al.Anterior fresh frozen structural allografts in the thoracic and lumbar spine.Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?［J］.Spine (Phila Pa 1976)，1995，20(12)：1410-1418.
［17］Xie YZ，Shi Y，Zhou Q，et al.Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion：A 1-year follow-up［J］.J Orthop Surg Res，2022，17(1)：360.
［18］汪文龙，刘正，吴四军，等.单侧双通道内镜下减压治疗腰椎管狭窄症的早期疗效观察［J］.中国脊柱脊髓杂志，2021，31(10)：911-918.
［19］刘建军，朱斌，陈磊，等.单边双通道内镜下椎管减压术和椎板间扩大开窗术治疗腰椎侧隐窝狭窄症的疗效比较［J］.中华医学杂志，2022，102(11)：801-807.
［20］Hu Y，Fu H，Yang D，et al.Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis［J］.Front Surg，2023(9)：1061566.
［21］Park MK，Park SA，Son SK，et al.Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF)：1year followup［J］.Neurosurg Rev，2019，42(3)：753-761.
［22］朱斌，田大胜，陈磊，等.单边双通道内镜技术在腰椎疾病中的应用研究进展［J］.中华骨科杂志，2020，40(15)：1030-1038.
［23］王湘斌，王翀.单侧双通道内镜技术联合药物化疗在胸腰椎结核中的初步应用效果［J］.中华医学杂志，2023，103(15)：1148-1153.
［24］Pao JL，Lin SM，Chen WC，et al.Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis［J］.J Spine Surg，2020，6(2)：438-446.
［25］Heo DH，Hong YH，Lee DC，et al.Technique of biportal endoscopic transforaminal lumbar interbody fusion［J］.Neurospine，2020，17(Suppl 1)：S129-S137.
［26］Kang MS，Chung HJ，Jung HJ，et al.How I do it?Extraforaminal lumbar interbody fusion assisted with biportal endoscopic technique［J］.Acta Neurochir (Wien)，2021，163(1)：295-299.
［27］Wang X，Long Y，Li Y，et al.Biportal endoscopic decompression，debridement，and interbody fusion，combined with percutaneous screw fixation for lumbar brucellosis spondylitis［J］.Front Surg，2023(9)：1024510.
［28］Merter A，Karaeminogullari O，Shibayama M.Comparison of radiation exposure among 3 different endoscopic diskectomy techniques for lumbar disk herniation［J］.World Neurosurg，2020(139)：e572-e579.
［29］Kim JE，Choi DJ.Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy［J］.Clin Orthop Surg，2018，10(2)：248-252.
［30］Kang MS，You KH，Choi JY，et al.Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique［J］.Spine J，2021，21(12)：2066-2077.
［31］Wang X，Tian Z，Mansuerjiang M，et al.A singlearm retrospective study of the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis［J］.Front Surg，2023(9)：1062451.
［32］Choi DJ，Choi CM，Jung JT，et al.Learning curve associated with complications in biportal endoscopic spinal surgery：Challenges and strategies［J］.Asian Spine J，2016，10(4)：624-629.
［33］Dong，Hwa，Heo，et al.Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery［J］.Neurosurgical focus，2019，46(4)：E18.
［34］Liu X，Han F，Zhao P，et al.Layer-by-layer self-assembled multilayers on PEEK implants improve osseointegration in an osteoporosis rabbit model［J］.Nanomedicine，2017，13(4)：1423-1433.
［35］Lee HG，Kang MS，Kim SY，et al.Dural injury in unilateral biportal endoscopic spinal surgery［J］.Global Spine J，2021，11(6)：845-851.
［36］倪双洋，张永远，孙宏慧，等.单侧双通道脊柱内镜下手术治疗腰椎管狭窄症的并发症及处理措施的研究进展［J］.中国脊柱脊髓杂志，2022，32(7)：659-662.
［37］于同，矫健航，吴敏飞.单侧双通道内镜技术治疗腰椎退行性疾病的手术并发症的研究进展［J］.中华医学杂志，2023，103(3)：224-228.
［38］朱劲松，杨民，徐祝军，等.后路经椎弓根螺钉内固定治疗胸腰椎骨折治疗失败原因分析［J］.中华创伤骨科杂志，2016，18(3)：253-256. |
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