<p>Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up</p>

Abstract

Although lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients. Patients and Methods: A retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria. Results: There are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05). Conclusion: Both full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.

Full-Endoscopic Lumbar Decompression versus Open Decompression and Fusion Surgery for the Lumbar Spinal Stenosis: A 3-Year Follow-Up Study

“…The total prevalence of complications and revision procedures was similar to that reported previously. 12,24,29,30 The success rate of FELDS reached 86.55%, which was similar to that for ODFS. Furthermore, we undertook FELDS to treat LSS at a relatively earlier phase; a lack of experience and appropriate instruments could lead to a prolonged procedure, neural injury, and insufficient decompression.…”

Case Report: Five-Level Unilateral Laminectomy Bilateral Decompression (ULBD) by Two-Stage Unilateral Biportal Endoscopy (UBE)

“…The ULBD technique was first reported by Young in 1988, and it has been rapidly improved by the use of various minimally invasive techniques, such as microscopy and microendoscopy. Nevertheless, the air medium required under microscopy and microendoscopy cannot provide a clear visual field, especially in contralateral decompression procedures ( 4 , 5 ). Full endoscopic ULBD can achieve effective bilateral decompression via water medium, and several studies have reported favorable outcomes from this version of the procedure in the treatment of LSS ( 6 ).…”

Five-Level Unilateral Laminectomy Bilateral Decompression (ULBD) by Two-Stage Unilateral Biportal Endoscopy (UBE)

“…Nevertheless, the air medium required under microscopy and microendoscopy cannot provide a clear visual eld, especially in contralateral decompression procedures. [4,5] Full endoscopic ULBD can achieve effective bilateral decompression via water medium, and several studies have reported favorable outcomes from this version of the procedure in the treatment of LSS. [6] However, full endoscopic ULBD has a steep learning curve and a high rate of complications.…”