Endoscopic Unilateral Approach for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis: Technique and Outcome

BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) was adopted instead of traditional expanding laminectomy in the treatment of lumbar spinal stenosis (LSS).OBJECTIVE: The aim of this study was to evaluate the clinical and radiological outcomes of the endoscopic unilateral laminotomy for bilateral decompression (ULBD) approach in patients with multilevel lumbar spinal stenosis.METHODS: This is a retrospective clinical and radiological study of 42 patients treated with endoscopic ULBD for multilevel LSS at our center. The perioperative results were evaluated, including blood loss, length of hospital stay, and complications within one month postoperatively. Preoperative and postoperative magnetic resonance imaging (MRI) scans were performed. A functional evaluation was conducted using Oswestry disability index (ODI) questionnaire. Low back and leg pain were assessed preoperatively and postoperatively at follow-up visits using visual analog scale (VAS). Macnab’s criteria were applied at the last postoperative follow-up for clinical efficacy evaluation.RESULTS: The mean operative time was 119.6±13.7 minutes. The mean intraoperative blood loss was 76.4±19.1mL. The mean length of hospital stay was 1.7 days. Operation-related complications were identified in two (4.8%) of the 42 patients. The VAS scores at postoperative 3 months, 6 months, and last follow-up (back VAS: 1.8±0.67, 1.72±0.63, 1.54±0.67 respectively; leg VAS: 2.9±1.47, 2.18±1.22, 1.68±0.72 respectively) were significantly better than the preoperative ones (back VAS: 2.9±1.04; leg VAS: 6.45±1.14). Similarly, the ODI score at postoperative 3 months, 6 months, and last follow-up (21.95±4.78, 17.22±4.09, 13.31±2.07 respectively) were significantly better than the preoperative one (43.54 ± 11.75). Macnab’s criteria revealed satisfactory subjective outcomes (good to excellent results) in 39 patients (92.9%) at the final follow-up.CONCLUSION: Endoscopic ULBD in multiple LSS relieves pain and improves patient’s quality of life and satisfaction. The procedure is safe with positive results.