Li Dongyue, Cheng Yunzhong, Yin Peng, Su Qingjun
Orthopaedic Department, Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
Front Surg. 2025 May 30;12:1601944. doi: 10.3389/fsurg.2025.1601944. eCollection 2025.
Biportal endoscopic bilateral decompression (BEBD) has gained recognition for treating lumbar spinal stenosis (LSS) through preservation of posterior spinal structures while achieving bilateral neural decompression. However, the relationship between postoperative radiographic findings and clinical outcomes remains unclear. This study investigates clinical efficacy, radiographic findings, and their potential correlations following BEBD.
A retrospective cohort analysis of 51 LSS patients undergoing BEBD (January 2020-December 2021) was conducted. Intraoperative parameters, complications, and clinical outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Modified Macnab criteria] were evaluated preoperatively, at 1 month, and final follow-up. Radiographic parameters included medial facetectomy surface angle (MFSA), facet joint preservation rate (FJPR), lateral recess decompression rate (LRDR), dural sac cross-sectional area expansion rate (DSCAER), and segmental range of motion (SROM).
The procedure demonstrated the mean operative time of 93.6 ± 13.7 min, with follow-up 36-60 months (mean 42.5 ± 6.7 months). Clinically, lower back pain (VAS: 5.9 ± 0.9-2.3 ± 0.6 at 1 month; 0.6 ± 0.5 final) and leg pain (6.8 ± 0.9-1.7 ± 0.6 at 1 month; 0.5 ± 0.6 final) showed sustained, statistically significant reductions ( < 0.05). Functional recovery was marked by ODI improvements from 64.5 ± 7.5 preoperatively to 26.1 ± 2.8 (1 month) and 11.0 ± 2.3 (final) ( < 0.05), with 88.24% (45/51) achieving excellent/good outcomes by modified Macnab criteria. Radiographically, MFSA remained <90°, FJPR exceeded 70%, and DSCAER expanded by 95.19 ± 22.5% ( < 0.05), while SROM stability was preserved ( > 0.05). Notably, no radiographic findings correlated with clinical outcomes stratification ( > 0.05), underscoring the multifactorial nature of postoperative success.
BEBD demonstrates significant clinical improvement in LSS patients, with marked DSCA expansion and preserved FJ stability. The technique achieves effective bilateral decompression with preserved biomechanical stability. Radiographic findings showed no correlation with clinical success, indicating multifactorial postoperative influences.
双门内镜双侧减压术（BEBD）通过保留脊柱后部结构实现双侧神经减压，在治疗腰椎管狭窄症（LSS）方面已获得认可。然而，术后影像学表现与临床疗效之间的关系仍不明确。本研究调查了BEBD术后的临床疗效、影像学表现及其潜在相关性。
对51例行BEBD的LSS患者（2020年1月至2021年12月）进行回顾性队列分析。评估术前、术后1个月和最终随访时的术中参数、并发症及临床疗效[视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、改良Macnab标准]。影像学参数包括内侧小关节切除表面角（MFSA）、小关节保留率（FJPR）、侧隐窝减压率（LRDR）、硬膜囊横截面积扩大率（DSCAER）和节段活动度（SROM）。
该手术平均手术时间为93.6±13.7分钟，随访36 - 60个月（平均42.5±6.7个月）。临床上，下腰痛（VAS：术后1个月5.9±0.9至2.3±0.6；最终随访0.6±0.5）和腿痛（术后1个月6.8±0.9至1.7±0.6；最终随访0.5±0.6）持续显著降低（P<0.05）。功能恢复表现为ODI从术前的64.5±7.5改善至术后1个月的26.1±2.8以及最终随访的11.0±2.3（P<0.05），根据改良Macnab标准，88.24%（45/51）的患者获得了优/良结果。影像学上，MFSA仍<90°，FJPR超过70%，DSCAER扩大了95.19±22.5%（P<0.05），同时SROM保持稳定（P>0.05）。值得注意的是，没有影像学表现与临床疗效分层相关（P>0.05），这突出了术后成功的多因素性质。
BEBD在LSS患者中显示出显著的临床改善，DSCA显著扩大且FJ稳定性得以保留。该技术实现了有效的双侧减压并保留了生物力学稳定性。影像学表现与临床成功无关，表明术后存在多因素影响。
