Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation

Abstract

Study Design: Retrospective cohort study. Objectives: To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation. Methods: A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels. Results: The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was “excellent” or “good” in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the “excellent” or “good” results of the Macnab criteria in 69% of the patients. Conclusions: Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

“…The position of the incision is slightly different among reports but is generally 0.5–2 cm from the midline ( 5 – 7 , 24 , 25 ). Endoscopic ULBD can improve surgical visualization, reduce postoperative low back pain, and shorten postoperative hospital stay ( 6 , 7 , 18 , 24 , 25 ). Some scholars have reported the utilization of unilateral biportal endoscopic ULBD, with the insertion point being more medial than that in unilateral biportal endoscopic interbody fusion (UBE) to protect facet joints, resulting in positive clinical outcomes ( 26 ).…”

“…With advancements in lumbar endoscopic technology, endoscopic ULBD has been widely studied and applied since 2020 ( 24 ). The position of the incision is slightly different among reports but is generally 0.5–2 cm from the midline ( 5 – 7 , 24 , 25 ). Endoscopic ULBD can improve surgical visualization, reduce postoperative low back pain, and shorten postoperative hospital stay ( 6 , 7 , 18 , 24 , 25 ).…”

“…Spetzger et al ( 3 ) first proposed the concept of unilateral laminotomy for bilateral decompression (ULBD). With advancements in technology, surgeons introduced tubular technology and endoscopic technology into ULBD, achieving satisfactory clinical outcomes ( 4 – 7 ).…”

Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study

“…Yoshikane et al reported the efficacy of lumbar endoscopic unilateral laminotomy for bilateral decompression in the treatment of postoperative recurrence of LSS, observing excellent pr good results in 69% of the patients according to the Macnab criteria. 26 In addition, significant improvements were observed in the numerical rating scale (NRS) for low back pain, NRS-lower leg pain, NRS-lower leg numbness, and walking ability of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). In our study, the results showed that VAS leg pain score improved from 6.1±1.0 preoperatively to 2.0±1.2 postoperatively, VAS back pain score improved from 6.2±0.8 preoperatively to 2.1±1.1 postoperatively, and ODI improved from 68.9±6.0 preoperatively to 20.9±5.6 postoperatively.…”

Evaluation of the efficacy and safety of conventional and interlaminar full-endoscopic decompressive laminectomy to treat lumbar spinal stenosis (ENDO-F trial): Protocol for a prospective, randomized, multicenter trial

“…Previous studies have reported that the clinical outcomes of interlaminar full-endoscopic laminectomy are not different from those of conventional laminectomy [ 13 – 15 , 19 – 22 ]. However, all previous studies comparing interlaminar full-endoscopic laminectomy and conventional open laminectomy are retrospective or single-center prospective studies [ 4 , 13 – 15 , 20 , 21 , 23 – 25 ]; therefore, a multicenter, randomized controlled trial (RCT) is needed.…”