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Full-endoscopic versus microscopic unilateral laminotomy for bilateral decompression of lumbar spinal stenosis at L4–L5: comparative study

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Abstract

Purpose

Full-endoscopic spine surgery for degenerative lumbar diseases is growing in popularity and has shown favourable outcomes. Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been used to treat lumbar spinal stenosis (LSS). However, studies comparing LE-ULBD to microscopic ULBD are lacking. This study compared the clinical efficacy and radiological outcomes between the LE-ULBD and microscopic ULBD.

Methods

The study retrospectively enrolled patients undergoing either LE-ULBD or microscopic ULBD for spinal stenosis at the L4–L5 level. The demographic data, operative details, radiological images, clinical outcomes, and complications of patients from the two groups were compared through matched-pairs analysis. The minimum follow-up duration was 24 months.

Results

There were 93 patients undergoing either LE-ULBD (n = 42) or microscopic ULBD (n = 51). The patient demographics were similar between the two groups. The LE-ULBD group had significantly less estimated blood loss, less analgesic use, and shorter hospitalization duration (P < .05). The endoscopic group had a significantly lower visual analog scale for back pain at all follow-up intervals compared with the microscopic group (P < .05). There were no significant differences in leg pain or Oswestry Disability Index. The cross-section area of the spinal canal was significantly wider after microscopic ULBD. There were no significant differences in post-operative degenerative changes in disc height, translational motion, or facet preservation rate.

Conclusions

LE-ULBD is comparable in clinical and radiological outcomes with enhanced recovery for single-level LSS. The endoscopic approach might further minimize tissue injury and enhance post-operative recovery.

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Funding

This research is supported by a grant from Korea’s Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HC20C0163). The funder had no role in the design of the study or collection, analysis, interpretation of data, or writing the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan

    Kuo-Tai Chen

  2. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Kuo-Tai Chen

  3. Department of Neurosurgery, Seoul Top Spine Hospital, Goyang, Korea

    Kyung-Chul Choi & Hyeong-Ki Shim

  4. Department of Neurosurgery, the Leon Wiltse Memorial Hospital, Anyang, Korea

    Dong-Chan Lee

  5. Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, 222, Korea

    Jin-Sung Kim

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Contributions

The corresponding author J-SK contributed to the conceptualization and methodology. The first author K-TC wrote the first draft of the manuscript with the corresponding author. The co-author D-CL conducted the workflow of the surgical techniques and clinical protocols. Material preparation, data collection, and analysis were performed by K-CC and H-KS. K-TC was responsible for the pictures and tables editing work. The corresponding author, J-SK, was responsible for proofreading and revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jin-Sung Kim.

Ethics declarations

Ethics approval

This manuscript was approved by the Institutional Review Board of the Leon Wiltse Memorial Hospital (2018-W06), and all patients had informed consent.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1 and 2a, b.

Conflict of interest

The corresponding author, Jin-Sung Kim, is the consultant of Richard Wolf, GmbH, and Elliquence, LLC. The author Kuo-Tai Chen is the consultant of Maxmore, GmbH. The authors have no personal, financial, or institutional interest in any of the drugs or devices described in this article.

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Chen, KT., Choi, KC., Shim, HK. et al. Full-endoscopic versus microscopic unilateral laminotomy for bilateral decompression of lumbar spinal stenosis at L4–L5: comparative study. International Orthopaedics (SICOT) 46, 2887–2895 (2022). https://doi.org/10.1007/s00264-022-05549-0

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