Comparative Outcomes of Biportal Endoscopic Decompression, Conventional Subtotal Laminectomy, and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Central Stenosis

Abstract

Objective: Spinal stenosis is a prevalent condition; however, the optimal surgical treatment for central lumbar stenosis remains controversial. This study compared the clinical outcomes and radiological parameters of 3 surgical.

Methods: unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (ULBD-UBE), conventional subtotal laminectomy (STL), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: This retrospective study included 86 patients, divided into ULBD-UBE (n=34), STL (n=24), and MIS-TLIF (n=28) groups. We evaluated demographics and perioperative factors and assessed clinical outcomes using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and neurogenic intermittent claudication (NIC). Radiological parameters assessed included lumbar lordosis, L4S1 Cobb angle (L4S1), T12S1 Cobb angle (T12S1), increased cross-sectional dural area (CSA), dynamic angulation (DA), dynamic slip (DS), and development of postoperative instability.

Results: The ULBD-UBE group showed a significantly shorter hospital stay duration and operation time and reduced blood loss than the other groups (p<0.001). ULBD-UBE group showed a trend towards greater VAS and ODI improvement at 1 month and postoperative NIC symptom relief. Radiologically, MIS-TLIF group exhibited lower postoperative DA and DS (p<0.001), indicating higher postoperative stability. Postoperative instability was lower in the ULBD-UBE group (2.9%) than in the STL group (16.7%) and similar to the MIS-TLIF group (0.0%) (p=0.028). The CSA was highest in the MIS-TLIF group (295.5%) compared to that in the other groups (ULBD-UBE, 216.3%; STL, 245.2%) (p<0.001).

Conclusion: Compared to other procedures, ULBD-UBE is a safe, effective, and viable surgical procedure for treating lumbar central stenosis.

Keywords: Biportal endoscopy; Decompression; Endoscopic spine surgery; Spinal stenosis.

Fig. 1.

(A, B) Measurement of dynamic angulation (DA) and dynamic slip (DS). DA is defined as the difference in sagittal angulation change between flexion (SA_F) and extension (SA_E) (DA=SA_F–SA_E); DS is the difference in segmental translation between flexion (ST_F) and extension (ST_E) (DS=ST_F–ST_E). To measure the segmental angle (SA), tangent lines are drawn along the lower endplate of the superior vertebra and upper endplate of the inferior vertebra. For segmental translation (ST), a perpendicular line is drawn from the posterior margin of the lower endplate of the superior vertebra to the line of the upper endplate of the inferior vertebra.

Fig. 2.

Measurement of dural sac cross-sectional area (DCSA) (mm2) on preoperative (A) and postoperative (B) magnetic resonance imaging. Increase in cross-sectional area (CSA)=postoperative DCSA/preoperative DCSA×100 (%). DCSA, dural sac cross-sectional area.

Fig. 3.

Comparison of preoperative and postoperative magnetic resonance imaging in 3 different surgeries: unilateral biportal endoscopy (A), conventional subtotal laminectomy (B), and minimally invasive transforaminal lumbar interbody fusion (C).