Unilateral Endo-LIF in treating central lumbar spinal stenosis

To investigate the clinical efficacy and morphological alterations in the central canal following unilateral-approach endoscopic lumbar interbody fusion (Endo-LIF) for treating central lumbar spinal stenosis (CLSS) with neurogenic claudication. From January 2021 to January 2023, 33 patients with CLSS who received unilateral Endo-LIF were retrospectively analyzed. A qualitative analysis of dural sac morphology was performed utilizing MRI scans. The dural sac cross-sectional area (DSCA), contralateral ligamentum flavum thickness (LFT) and contralateral foramen height (FH) were quantitatively measured. The clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. This study enrolled 33 patients with a mean follow-up period of 22.57 months. Qualitative central canal parameters significantly improved after unilateral-approach Endo-LIF (p < 0.001). Compared with preoperative value, significant increases in DSCA (90.7 ± 30.7%) and contralateral FH (19.7 ± 5.0%), and significant decreases in contralateral LFT (20 ± 4.0%) were found (p < 0.001). Postoperative VAS and ODI scores showed statistically significant decreases at all follow-up intervals (1, 3, and 12 months) and at final assessment (p < 0.05). The patients were rated as excellent in 19 cases and good in 12 cases (93.9%) based on the modified MacNab standard. Unilateral-approach Endo-LIF can significantly improve the area of the central canal. Therefore, Endo-ILF unilateral direct decompression may be a promising option for CLSS with bilateral symptoms. (one side is mild).