Application of Unilateral Biportal Endoscopy Technique in the Treatment of Lumbar Brucellosis Spondylitis

Abstract

Background The unilateral biportal endoscopy (UBE) technique is a new minimally invasive spinal surgical technique, which has been used to treat various degenerative spinal diseases in recent years. However, there is no literature reporting this technique for the treatment of lumbar brucellosis spondylitis (LBS) . Objective To investigate the effectiveness and feasibility of the UBE technique in the treatment of LBS. Methods This study selected 13 patients with LBS who received the UBE treatment in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2020 to June 2021. The operative duration, the estimated blood loss and complications were recorded. Clinical outcomes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), American Spinal Injury Association (ASIA) neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at 1-year follow-up after operation. The intervertebral bone graft fusion was evaluated using Bridwell grading criteria. Results The operation time was 145-210 minutes, with an average of (177.31±19.54) minutes. The estimated blood loss was 120-290 ml, with an average of (176.15±43.79) ml. There were 2 complications, with an incidence rate of 2/13. ESR and CRP levels returned to normal at the 3-month follow-up. The VAS scores of low back and leg, JOA score, and ODI were significantly improved compared to those before operation at each postoperative follow-up time point, and the differences were statistically significant (P<0.05). The modified Macnab criteria evaluation at 1-year follow-up showed that the outcomes were excellent in 10 cases, good in 2 cases, fair in 1 case, and no patient showed poor outcomes, with a rate of excellent and good was 12/13. The lordotic angle decreased from preparation (47.18°±6.88°) to predischarge (40.83°±6.71°), and there was no significant loss of angle at 1-year follow-up after operation. Bony fusion was obtained in all patients at 1-year follow-up after operation, of which 12 cases were grade Ⅰ and 1 case was grade Ⅱ, with a fusion rate of 12/13. Conclusion UBE technique is an effective, safe and feasible surgical procedure for treating LBS.

Keywords

• brucellosis|lumbar brucellosis spondylitis|unilateral biportal endoscopy technique|debridement|interbody fusion|minimally invasive surgery