Early Clinical and Radiologic Evaluation of Unilateral Biportal Endoscopic Unilateral Laminotomy and Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study

Jianjian Yin; Tao Ma; Gongming Gao; Qi Chen; Luming Nong

doi:10.1055/a-2281-2135

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2025; 86(05): 428-436
DOI: 10.1055/a-2281-2135

Original Article

Early Clinical and Radiologic Evaluation of Unilateral Biportal Endoscopic Unilateral Laminotomy and Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study

Authors

Jianjian Yin^*

¹Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
Tao Ma^*

¹Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
Gongming Gao

¹Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
Qi Chen

¹Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
Luming Nong

¹Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China

Abstract

Background

The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis.

Methods

Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation.

Results

The VAS for back and leg pain improved from 7.24 ± 0.80 and 7.59 ± 0.59 preoperatively to 2.41 ± 0.55 and 2.37 ± 0.62 (p < 0.05) postoperatively and 1.37 ± 0.54 and 1.51 ± 0.55 at the last follow-up (p < 0.05). For ODI, improvement from 60.37 ± 4.44 preoperatively to 18.90 ± 4.66 (p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 ± 87.81 to 232.97 ± 88.42 mm (p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 ± 3.13 and 19.57 ± 3.80 to 22.19 ± 4.56 and 21.04 ± 3.72 mm, respectively (p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 ± 1.12 and 3.20 ± 1.14 mm preoperatively and 4.03 ± 1.37 and 3.83 ± 1.32 mm (p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively.

Conclusion

The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.

Keywords

lumbar spinal stenosis - unilateral biportal endoscopic - unilateral laminotomy bilateral decompression - radiologic parameter

Full Text

References

References
1 Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and management of lumbar spinal stenosis: a review. JAMA 2022; 327 (17) 1688-1699
2 Issack PS, Cunningham ME, Pumberger M, Hughes AP, Cammisa Jr FP. Degenerative lumbar spinal stenosis: evaluation and management. J Am Acad Orthop Surg 2012; 20 (08) 527-535
3 Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus nonsurgical treatment for lumbar spinal stenosis. Spine 2016; 41 (14) E857-E868
4 Hasan S, McGrath LB, Sen RD, Barber JK, Hofstetter CP. Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis. Neurosurg Focus 2019; 46 (05) E16
5 Jiang Y, Yin J, Nong L, Xu N. Uniportal full-endoscopic versus minimally invasive decompression for lumbar spinal stenosis: a meta-analysis. J Neurol Surg A Cent Eur Neurosurg 2022; 83 (06) 523-534
6 Xue J, Chen H, Zhu B. et al. Percutaneous spinal endoscopy with unilateral interlaminar approach to perform bilateral decompression for central lumbar spinal stenosis: radiographic and clinical assessment. BMC Musculoskelet Disord 2021; 22 (01) 236
7 Yang F, Chen R, Gu D. et al. 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. J Pain Res 2020; 13: 1377-1384
8 Xu WB, Kotheeranurak V, Zhang HL. et al. Is biportal endoscopic spine surgery more advantageous than uniportal for the treatment of lumbar degenerative disease? A meta-analysis. Medicina (Kaunas) 2022; 58 (11) 1523
9 Pao JL, Lin SM, Chen WC, Chang CH. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. J Spine Surg 2020; 6 (02) 438-446
10 Kim JE, Choi DJ. Clinical and radiological outcomes of unilateral biportal endoscopic decompression by 30° arthroscopy in lumbar spinal stenosis: minimum 2-year follow-up. Clin Orthop Surg 2018; 10 (03) 328-336
11 Kim N, Jung SB. Percutaneous unilateral biportal endoscopic spine surgery using a 30-degree arthroscope in patients with severe lumbar spinal stenosis: a technical note. Clin Spine Surg 2019; 32 (08) 324-329
12 Dohzono S, Matsumura A, Terai H, Toyoda H, Suzuki A, Nakamura H. Radiographic evaluation of postoperative bone regrowth after microscopic bilateral decompression via a unilateral approach for degenerative lumbar spondylolisthesis. J Neurosurg Spine 2013; 18 (05) 472-478
13 Young S, Veerapen R, O'Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 1988; 23 (05) 628-633
14 Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine 1999; 24 (21) 2268-2272
15 McGrath LB, White-Dzuro GA, Hofstetter CP. Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine 2019; 30 (04) 491-499
16 Heo DH, Lee N, Park CW, Kim HS, Chung HJ. Endoscopic unilateral laminotomy with bilateral discectomy using biportal endoscopic approach: technical report and preliminary clinical results. World Neurosurg 2020; 137: 31-37
17 Zheng B, Xu S, Guo C, Jin L, Liu C, Liu H. Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: a systematic review and meta-analysis. Front Surg 2022; 9: 911914
18 Kim HS, Choi SH, Shim DM, Lee IS, Oh YK, Woo YH. Advantages of new endoscopic unilateral laminectomy for bilateral decompression (ULBD) over conventional microscopic ULBD. Clin Orthop Surg 2020; 12 (03) 330-336
19 Kim SK, Ryu S, Kim ES, Lee SH, Lee SC. Radiologic efficacy and patient satisfaction after minimally invasive unilateral laminotomy and bilateral decompression in patients with lumbar spinal stenosis: a retrospective analysis. J Neurol Surg A Cent Eur Neurosurg 2020; 81 (06) 475-483
20 Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am 2011; 93 (21) 1979-1986
21 Song Q, Liu X, Chen DJ. et al. Evaluation of MRI and CT parameters to analyze the correlation between disc and facet joint degeneration in the lumbar three-joint complex. Medicine (Baltimore) 2019; 98 (40) e17336
22 Erbulut DU. Biomechanical effect of graded facetectomy on asymmetrical finite element model of the lumbar spin. Turk Neurosurg 2014; 24 (06) 923-928
23 Choi KC, Shim HK, Hwang JS. et al. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg 2018; 116: e750-e758
24 Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus 2019; 46 (05) E9
25 Guo S, Tan H, Meng H. et al. Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar spine surgery. Front Surg 2022; 9: 966197
26 Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res 2022; 17 (01) 30
27 Lin GX, Yao ZK, Xin C, Kim JS, Chen CM, Hu BS. A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis. Front Surg 2022; 9: 1002100
28 Park HJ, Kim SK, Lee SC, Kim W, Han S, Kang SS. Dural tears in percutaneous biportal endoscopic spine surgery: anatomical location and management. World Neurosurg 2020; 136: e578-e585
29 Kim W, Kim SK, Kang SS, Park HJ, Han S, Lee SC. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir (Wien) 2020; 162 (02) 279-287
30 Shi B, Li X, Li H, Ding Z. The morphology and clinical significance of the dorsal meningovertebra ligaments in the lumbosacral epidural space. Spine 2012; 37 (18) E1093-E1098
31 Lee HG, Kang MS, Kim SY. et al. Dural injury in unilateral biportal endoscopic spinal surgery. Global Spine J 2021; 11 (06) 845-851
32 Kim JE, Choi DJ, Kim MC, Park EJ. Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg 2019; 129: e324-e329
33 Chen Z, Zhou H, Wang X, Liu Z, Liu W, Luo J. Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a meta-analysis and systematic review. World Neurosurg 2023; 170: e371-e379
34 Ahn DK, Lee JS, Shin WS, Kim S, Jung J. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore) 2021; 100 (06) e24685
35 Choi DJ, Kim JE. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. Clin Orthop Surg 2019; 11 (01) 82-88
36 Park SM, Kim HJ, Kim GU. et al. Learning curve for lumbar decompressive laminectomy in biportal endoscopic spinal surgery using the cumulative summation test for learning curve. World Neurosurg 2019; 122: e1007-e1013
37 Chen L, Zhu B, Zhong HZ. et al. The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis. Front Surg 2022; 9: 873691
38 Xu J, Wang D, Liu J. et al. Learning curve and complications of unilateral biportal endoscopy: cumulative sum and risk-adjusted cumulative sum analysis. Neurospine 2022; 19 (03) 792-804