Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar spine surgery

Abstract

BackgroundUnilateral biportal endoscopic (UBE) spine surgery is a minimally invasive procedure for treating lumbar disorders. Hidden blood loss (HBL) is easily ignored by surgeons because blood loss is less visible. However, there are limited studies on HBL in UBE spine surgery. This study aimed to evaluate HBL and its possible risk factors in patients undergoing UBE spine surgery.MethodsPatients with lumbar disc herniation or lumbar spinal stenosis who underwent unilateral biportal endoscopic surgery between December 2020 and February 2022 at our hospital were retrospectively analyzed. Patient demographics, blood loss-related parameters, and surgical and radiological information were also collected. Pearson or Spearman correlation analysis was conducted to determine the association between clinical characteristics and HBL. Multivariate linear regression analysis was used to determine the independent risk factors for HBL.ResultsFifty-two patients (17 males and 35 females) were retrospectively enrolled in this study. The mean total blood loss (TBL) volume was 434 ± 212 ml, and the mean HBL volume was 361 ± 217 ml, accounting for 77.9% of the TBL in patients who underwent UBE surgery. Multivariate linear regression analysis revealed that HBL was positively associated with operation time (P = 0.040) and paraspinal muscle thickness at the target level (P = 0.033).ConclusionsThe amount of HBL in patients undergoing UBE surgery should not be neglected. Operation time and paraspinal muscle thickness at the target level may be independent risk factors for HBL.

Hidden blood loss in three different endoscopic spinal procedures for lumbar disc herniation

“…Pearson or Spearman correlation analysis showed that sex may be associated with HBL in the PETD group, with female patients having less HBL than male patients, which may be related to the relatively small amount of bone resection and smaller back muscles in women than in men. Guo et al 18 found that the HBL increases with the thickness of the paraspinal muscles at target levels in the UBE. From this, it could be seen that women have relatively weak back muscles and therefore have less HBL than men.…”

“…Wang et al 17 reported that the mean HBL during UBE spine surgery was 469.5±195.3 ml, accounting for 57.6% of TBL. Guo et al 18 reported a mean HBL volume of 361.4±216.8 ml in patients treated with UBE lumbar spine surgery. Hu et al 19 retrospectively analyzed 74 patients diagnosed with LDH and treated with PETD, with an HBL of 341.04±191.15 ml.…”

Title：Percutaneous endoscopic interlaminar discectomy versus unilateral biportal endoscopy in the treatment of L5/S1 degeneration disease: a randomized controlled trial

“…The overall complication rate of UBE surgery for lumbar spinal stenosis was 8.1% [29][30] . Among them, dural tear is the most common complication with an incidence of about 1.5-9.7% [31][32][33][34] . While most dural tears are small and can be managed conservatively, dural tears larger than 10mm require repair to prevent cerebrospinal uid leakage and other sequelae.…”

Why does such a cyst appear after unilateral biportal endoscopy surgery: A case report and literature review

“…[ 3 ] Although UBE may inferior to other spinal endoscopic techniques, it has its own merits which can make it stand out in comparison to the conventional surgeries, for example, the smaller surgical incision, the less pain of patients early after operation, the flexible operation, its wide vision and short learning curve which are worth promoting in primary hospitals. [ 4 ]…”