Comparison of Endoscopic Unilateral Laminectomy for Bilateral Decompression (Endo-ULBD) and Posterior Lumbar Interbody Fusion (PLIF) in Managing Multi-Segmental Lumbar Spinal Stenosis: Technique and Early Outcomes.

OBJECTIVES

Lumbar spinal stenosis is a common degenerative spine condition that leads to severe pain and disability. Surgical intervention is often required when conservative treatments fail, but the choice between different surgical techniques remains a topic of ongoing debate. The objective of this study was to provide a comprehensive comparison of the safety and efficacy of endoscopic unilateral laminectomy with bilateral decompression (Endo-ULBD) and posterior lumbar interbody fusion (PLIF) in the treatment of multi-segmental lumbar spinal stenosis (MS-LSS). Furthermore, the text provides detailed technical information regarding the Endo-ULBD procedure.

METHODS

This retrospective comparative study was conducted from October 2019 to October 2022 and involved 73 patients diagnosed with MS-LSS. Of the total number of patients, 36 were treated with Endo-ULBD and 37 with PLIF. The technical parameters of both procedures were recorded, including perioperative factors such as patient demographic characteristics (age, gender, BMI), disease duration, number of surgical segments involved, type of anesthesia, duration of surgery, estimated blood loss (EBL), postoperative length of stay, time to discharge, use of intraoperative fluoroscopy, and any intraoperative complications. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), the Japanese Orthopedic Association (JOA) score, and the Oswestry Disability Index (ODI), which were assessed preoperatively and at follow-up. Radiologic improvement was quantified by comparing the preoperative and postoperative dural sac areas. Statistical analyses were conducted using paired t tests with a significance threshold of p < 0.05.

RESULTS

In comparison to the PLIF group, the Endo-ULBD group exhibited a markedly shorter operative time, diminished intraoperative bleeding, accelerated recovery of ambulation, and a shorter postoperative hospitalization period. Moreover, the Endo-ULBD group demonstrated a diminished prevalence of postoperative complications. However, it required a significantly greater number of intraoperative x-ray fluoroscopies than the PLIF group (p < 0.05). Postoperative VAS, ODI, and JOA scores demonstrated notable improvement in both groups, with a more pronounced trajectory observed in the Endo-ULBD cohort during the early postoperative period. Both surgical approaches resulted in a notable enlargement of the dural sac area. Neither group experienced any fatalities, irreversible nerve damage, or paralysis.

CONCLUSION

Endo-ULBD demonstrated superior early clinical outcomes compared to PLIF, including shorter operative time, reduced blood loss, faster recovery, and fewer complications. Both techniques provided similar improvements in dural sac decompression, but Endo-ULBD may offer a more efficient and minimally invasive treatment option for patients with MS-LSS. However, the high frequency of intraoperative fluoroscopy remains a limitation, highlighting the need for improved surgical techniques and positioning systems.