Uniportal Versus Biportal Endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: A Structured Debate and International Practice Patterns

Lumbar spinal stenosis is a common degenerative disorder that may cause neural compression, neurogenic claudication, radicular pain, and disability, particularly in the elderly; surgical decompression is established when conservative care fails. Endoscopic unilateral laminotomy for bilateral decompression (ULBD) is widely performed by 2 techniques: uniportal (UE-ULBD), 1 incision carrying a single channel for visualization and instrumentation, and biportal (BE-ULBD), separating viewing and working portals across 2 incisions. Superiority remains actively debated. This debate-style article presents advocacy for each technique across 7 contested domains: learning curve and training, technical feasibility, patient selection, clinical and radiological outcomes, complications, cost-effectiveness and reoperation, each prepared independently by the co-first authors. We surveyed 140 endoscopic spine surgeons in 39 countries across 6 continents (July 4–21, 2026), applying an a priori 70% agreement threshold overall, by platform-expertise subgroup and in sensitivity analyses restricted to dual-platform respondents. This was a single-round opinion survey, not a Delphi consensus; the literature component is a nonsystematic expert narrative debate. No clinically meaningful difference between techniques was demonstrated in patient-reported outcomes across validated instruments; a statistically significant 12-month Oswestry Disability Index difference favoring BE-ULBD in one meta-analysis fell below the minimal clinically important difference. Eight ULBD-related items were reported as survey agreement points (one only among respondents with comparative experience), with one additional agreement item concerning a separate foraminal decompression scenario; 9 items remained Points of Persistent Debate. Agreement on training, cost and research priorities held in every exposure stratum, whereas 2 platform-specific items fell below threshold among dual-platform surgeons performing 26 or more annual cases on both platforms. Disagreement persisted over operative efficiency, instrument versatility, decompression adequacy, and long-term economic sustainability; neither technique demonstrated superiority. Preference tracked the respondent’s own platform more than the pathology.

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Journal
Neurospine
Published
2026-10-29
DOI
https://doi.org/10.14245/ns.26521626.0813
Citations
3
Primary Topic
Spine and Intervertebral Disc Pathology
Type
article
Field-Weighted Citation Impact
13.72
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article

Uniportal Versus Biportal Endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: A Structured Debate and International Practice Patterns

Dimas Rahman Setiawan, Jae‐Joong Kim, Ian Bustorff Freire, Javier Quillo-Olvera et al.
3 citations
Neurospine
Spine and Intervertebral Disc Pathology
13.72
article

Uniportal Versus Biportal Endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: A Structured Debate and International Practice Patterns

Dimas Rahman Setiawan, Jae‐Joong Kim, Ian Bustorff Freire, Javier Quillo-Olvera, José Miguel Sousa, Akaworn Mahatthanatrakul, Dhawi A Alotaibi, Kandarpkumar K. Patel, Guang‐Xun Lin, Jin Young Lee, Hussam Essam Jabri, Richard Assaker, Elsa González Pérez, Asrafi Rizki Gatam, Christoph Paul Hofstetter, Vincent Hagel, Hyun‐Jin Park, Ariel Matias Kaen, Georgios Vastardis, Moritz C. Deml, Young San Ko, Kajetan Łątka, Ki-Eun Chang, Qingbing Meng, Catrina Scherrer
article en
3 citations

Abstract

Lumbar spinal stenosis is a common degenerative disorder that may cause neural compression, neurogenic claudication, radicular pain, and disability, particularly in the elderly; surgical decompression is established when conservative care fails. Endoscopic unilateral laminotomy for bilateral decompression (ULBD) is widely performed by 2 techniques: uniportal (UE-ULBD), 1 incision carrying a single channel for visualization and instrumentation, and biportal (BE-ULBD), separating viewing and working portals across 2 incisions. Superiority remains actively debated. This debate-style article presents advocacy for each technique across 7 contested domains: learning curve and training, technical feasibility, patient selection, clinical and radiological outcomes, complications, cost-effectiveness and reoperation, each prepared independently by the co-first authors. We surveyed 140 endoscopic spine surgeons in 39 countries across 6 continents (July 4–21, 2026), applying an a priori 70% agreement threshold overall, by platform-expertise subgroup and in sensitivity analyses restricted to dual-platform respondents. This was a single-round opinion survey, not a Delphi consensus; the literature component is a nonsystematic expert narrative debate. No clinically meaningful difference between techniques was demonstrated in patient-reported outcomes across validated instruments; a statistically significant 12-month Oswestry Disability Index difference favoring BE-ULBD in one meta-analysis fell below the minimal clinically important difference. Eight ULBD-related items were reported as survey agreement points (one only among respondents with comparative experience), with one additional agreement item concerning a separate foraminal decompression scenario; 9 items remained Points of Persistent Debate. Agreement on training, cost and research priorities held in every exposure stratum, whereas 2 platform-specific items fell below threshold among dual-platform surgeons performing 26 or more annual cases on both platforms. Disagreement persisted over operative efficiency, instrument versatility, decompression adequacy, and long-term economic sustainability; neither technique demonstrated superiority. Preference tracked the respondent’s own platform more than the pathology.

NeurospineVol. 23(4)
Naval Medical Center San Diego (US), Riyadh Armed Forces Hospital (SA), Shanghai Jiao Tong University (CN), Xiamen University (CN), University of Washington (US), University Hospital of Bern (CH), Kyungpook National University Hospital (KR), King Fahd Medical City (SA), Harborview Medical Center (US), University of Indonesia (ID), University of Sharjah (AE), Centre Hospitalier Universitaire de Lille (FR), Kyungpook National University (KR), Hospital Estadual Mário Covas (BR), First Affiliated Hospital of Xiamen University (CN), Hallym University Kangnam Sacred Heart Hospital (KR), Hôpital Roger Salengro (FR), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Kantonsspital Baden (CH), Centro Hospitalar de Lisboa Ocidental (PT), Shanghai First People's Hospital (CN), Faculdade de Medicina do ABC (BR), IASO General Hospital (GR), Hospital Universitario Virgen del Rocío (ES), Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (ID), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Asklepios (DE), Fatmawati Hospital (ID), Naresuan University (TH), Catholic University of Korea (KR)
Good health and well-being
Openalex Percentile: Top 1%
Spine and Intervertebral Disc Pathology
13.72
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