A Comparative Analysis of Bi-Portal Endoscopic Spine Surgery and Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Stenosis Patients

Abstract

The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent BESS and microscopic ULBD, respectively, who were diagnosed with multi-level lumbar stenosis. Clinical outcomes were evaluated using the visual analog scale score for both back and leg pain, and medication (pregabalin) use and Oswestry Disability Index (ODI) scores for overall treatment outcomes were used pre-operatively and at the final follow-up. Radiological outcomes were evaluated as the percentage of dura expansion volume, and percentage preservation of both facets and both lateral recess angles. The follow-up period of patients was about 17.04 months in the BESS group and about 16.90 months in the microscopic ULBD group. The back and leg visual analog scale (VAS) scores and average pregabalin use decreased more significantly in the BESS group than in the microscopic ULBD group (each p-value 0.0443, <0.001, 0.0378). All radiological outcomes were significantly higher in the BESS group than in the ULBD group. The change in ODI in two-level spinal stenosis showed a significantly higher value in the BESS group compared to the microscopic ULBD group (p-value 0.0335). Multilevel decompression with the BESS technique in multiple spinal stenosis is an adequate technique as it shows better clinical and radiological results than microscopic ULBD during a short-term follow-up period.

Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression

“…Following a rigorous assessment, 37 studies met the inclusion criteria and were included in this meta-analysis. 9,10,14,16,21-53 The Preferred Reporting Items for Systematic reviews and Meta-Analysis flow diagram of the literature search strategy is shown in Figure 1.…”

Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results

“…The portal change technique is considered the most challenging technique if the surgeon is unable to use both hands freely; however, it can be employed in clinical practice in procedures such as a laminectomy without flavectomy or discectomy; it can also be used to perform two-level surgeries. Moreover, in biportal spine fusion surgery, most L5–S1 procedures require left-hand operation for discectomy and cage placement [ 15 ]. The tilting technique is commonly employed in full endoscopic spine surgery; it has demonstrated efficacy as a multilevel procedure (more than three-level surgery) [ 16 ], with the ability to use more varied instruments [ 17 ] than the full endoscopic technique.…”

Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients

“…[ 4 32 33 ] FE-PSLD with uniportal approach is less invasive than biportal unilateral laminotomy for bilateral decompression (ULBD), even though the use of biportal ULBD was rapidly progressed due to its greater familiarity. [ 34 35 36 37 ] FE-PSLD can be argued to be superior to conventional surgery with several considerations: (1) Minimal blood loss and damaged anatomical structure, leading to less spinal instability complication and the need of future spinal fusion; (2) Ability to decompress single to multiple levels of LSS concurrently with single skin incision using uniportal access; and (3) Ability to decompress central and lateral recess LSS and excised herniated disc concomitantly with stenoscope by translaminar approach. [ 34 38 39 ] The feasibility of PSLD as effective management to replaced conventional open surgery for lumbar stenosis was also proven by Lim et al ., study on LSS patients which shown a significant increase of spinal canal volume, less soft-tissue damage by MRI, less hospital stay, and pain improvement with a mean score of 4.…”