A Review of Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Canal Stenosis

Abstract

Background: The unilateral biportal endoscopic (UBE) technique provides minimally invasive decompression for degenerative lumbar canal stenosis (DLCS). With appropriate control of the hydrostatic pressure of normal saline irrigation, the surgery can be performed in a clear and magnified surgical field through 2 small surgical wounds.Methods: A review of published literature in PubMed was performed to identify studies of UBE decompression for DLCS. The outcome measures include operation time, length of hospital stay, estimated blood loss, visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and the Macnab criteria.Results: A total of 76 relevant studies were retrieved through the PubMed search. After screening, 15 studies comprising 6 case series, 6 comparative studies, and 3 randomized controlled trials were included in this review. Significant improvements in pain and neurological symptoms were obtained in all studies. In the 6 case series studies, the outcome measures were extracted from each study and summarized. The follow-up periods ranged from 8.6 to 29 months. The operation time was 72.0 min. The VAS score for leg pain was reduced from 7.8 to 1.7, and the VAS score for back pain was reduced from 5.8 to 1.7. The ODI was reduced from 63.0 to 20.7, and 87.3% of patients reported good to excellent outcomes according to the Macnab criteria. The complication rates ranged from 5.5% to 13.8%, with dural tear having the highest incidence rate. In the comparative studies and randomized controlled trials examining the UBE, microscopic, microendoscopic, and uniportal endoscopic techniques, the UBE technique showed treatment results that were comparable with the others. Compared with the microscopic technique, the UBE technique resulted in significantly less tissue trauma and quicker recovery with less wound pain, lower serum creatine kinase and C-reactive protein levels, and lower ODI in the very early postoperative period. The UBE technique also provided adequate decompression with less facet joint destruction than all the other decompression techniques.Conclusions: The UBE technique is safe and effective for decompression of DLCS. Along with its efficacy in decompression, this technique is capable of preserving segmental stability. However, a long-term comparative study is required to verify this hypothesis.

Success and Complications of Microsurgical Over-Top Decompression for Lumbar Spine Stenosis: Experience in a Limited Resource Center

“…It has been reported that the complication rates with endoscopic decompression for lumbar spine stenosis range from 5.5% to 13.8%, with dural tear having the highest incidence. 18 In one of the studies, incidental durotomy was observed in 8.6% of cases 20-21. Çavuşoğlu and colleagues 22 reported that incidental durotomy is almost between 3.5 to 12% of the cases. Kim et al common complication in their study was dural tear (7.2%).…”

“…1 In a review study it was observed that the operation time for endoscopic bilateral decompression from a unilateral approach was 72 minutes. 18 In another such study, the average duration of the surgery was 89 ± 56.9 minutes (range, 50 -190 minutes). 6 The mean duration of surgery in our study was 56 minutes (range 35 -86 minutes).…”

Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: A technical report

“…UBE surgery has significant advantages, such as a good operative view, easy surgical manipulation, reduced blood loss, and decreased postoperative back pain. It has been considered a minimally invasive technique with favorable clinical outcomes and high patient satisfaction ( 17 ). For nonfusion endoscopic spinal surgery, the preservation of facet joints on the pathological side is the most crucial consideration ( 18 , 19 ).…”

Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis

“…In recent years, unilateral biportal endoscopy (UBE) has generated a wave of frenzied learning. It has an independent working and viewing portal, with the freer operation and higher decompression efficiency, which well overcomes the shortcomings of insufficient decompression in previous endoscopic surgery (11,12). And the feasibility of UBE with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of LSS has been confirmed to provide satisfactory clinical results (13,14).…”