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Decompression and Fusion Surgery
Spinal surgery is broadly divided into two categories: “decompression surgery” and “fusion surgery.” Decompression surgery is a procedure designed to improve the environment around the nerves by removing bone from the “vertebral arch”—the bony structure that forms the roof over the nerves—in order to widen the spinal canal, through which the compressed nerves pass. The primary indication for this procedure is lumbar spinal stenosis.
On the other hand, “spinal fusion” is a surgical procedure performed not only to relieve nerve compression but also to correct and stabilize the alignment of the spine in cases of spinal instability or overall spinal deformity. The main indications for this procedure include lumbar spondylolisthesis, lumbar spondylolysis, and scoliosis or kyphosis. Generally, a fixation device called a pedicle screw is required, which is inserted into the spine through an incision in the back.
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What Is Endoscopic Lumbar Interbody Fusion?
Lumbar interbody fusion is a surgical procedure in which damaged intervertebral disc tissue between the lumbar vertebrae is removed and replaced with bone harvested during the operation or an artificial implant called an interbody cage.
近年、脊椎手術の分野では内視鏡技術の進歩により、身体への負担をできるだけ抑えた低侵襲手術が広く行われるようになってきました。当院では、脊椎内視鏡手術の一つであるUnilateral Biportal Endoscopy（UBE）を導入し、腰椎椎体間固定術にも適応しています。
Compared to conventional fusion procedures that involve a large incision in the back, this method not only requires a smaller skin incision but also minimizes muscle damage. Its advantages include reduced postoperative pain, a shorter hospital stay, and a faster return to daily activities.
Comparison of Skin Incisions Between Conventional Fusion and UBE Fusion
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Details of the Surgical Procedure
Four small incisions are made on either side of the body to insert screws percutaneously. Through these incisions, an endoscope (camera) and surgical instruments are inserted between the muscles to perform nerve decompression and interbody procedures. Finally, screws are placed to stabilize the lumbar spine. Patients are generally able to walk the day after surgery and require a hospital stay of approximately 5–7 days. As with conventional fusion surgery, patients are required to wear a brace for 3–4 months postoperatively and should refrain from activities that place strain on the lower back for 6 months following surgery.
UBE Fusion in Practice
While conventional surgical methods required a large incision in the affected area, the UBE fusion procedure involves making a small incision and performing endoscopic manipulation and screw placement through the space between the muscles, thereby significantly reducing damage to the muscles.
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Precautions
This procedure may not be indicated in cases of severe nerve compression or significant lumbar spinal deformity or osteoporotic changes. Additionally, if the amount of bone harvested for intervertebral bone grafting is insufficient, bone may be harvested from the pelvis via a small incision.
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Representative Case (76-year-old woman)
The patient presented with walking difficulties due to pain in both lower limbs. As walking even 200 meters had become difficult, the patient was diagnosed with degenerative spondylolisthesis of the fourth lumbar vertebra and underwent endoscopic lumbar interbody fusion using the UBE system. After surgery, the lower-limb symptoms resolved. Postoperative MRI confirms that the spinal canal has widened.
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