Efficacy and Safety of Unilateral Interlaminar Endoscopic Decompression for Lumbar Spinal Stenosis: A Retrospective Study of 176 Cases With a 3–6 Year Follow-Up

Abstract

Objective: Spinal endoscopic surgery is widely acknowledged as an effective and minimally invasive approach for treating lumbar disc herniation. Comprehensive descriptions of the endoscopic decompression technique for lumbar spinal stenosis (LSS) are limited in existing literature. With a focus on long-term follow-up outcomes, this study investigates the safety and efficacy of endoscopic decompression using a unilateral interlaminar approach.

Methods: Between August 1, 2018, and December 1, 2020, a total of 316 consecutive cases underwent endoscopic decompression for LSS following conservative treatment. Based on specific selection criteria, 176 of these cases were retrospectively included in this study. The minimally invasive decompression was performed using a percutaneous uniportal and lateral interlaminar endoscopic approach under local anesthesia. This endoscopic procedure involved comprehensive decompression of the central canal and unilateral recess, addressing the lamina, hypertrophic ligamentum flavum (LF), and medial osteophytes of the facet joint. Clinical outcomes were assessed using the single continuous walking distance (SCWD) without pain, the modified MacNab criteria, the Oswestry Disability Index (ODI), and the visual analogue scale (VAS). Radiographic changes, both preoperative and postoperative, were documented and analyzed. This analysis included evaluating the stability of the lumbar spine through lumbar hyper-flexion and hyper-extension X-rays, as well as determining the lumbar canal cross-sectional area (CCA) using CT scans.

Results: The mean follow-up period was 47.4 ± 7.1 months. The average operative duration was 65.3 ± 12.6 min, and the mean estimated blood loss was 10.4 ± 8.5 mL. The average length of postoperative hospital stay was 2.2 ± 1.3 days. There was a significant improvement in SCWD without pain (p < 0.05). Postoperatively, the ODI and VAS scores for both back and leg pain showed significant reductions (p < 0.05). Based on the modified MacNab criteria, the overall rate of good-to-excellent outcomes was 95.45%. The CCA increased significantly from 52.0 ± 11.0 to 122.5 ± 12.1 mm² (p < 0.05). The stability of the spine did not exhibit significant changes compared to the preoperative state.

Conclusions: The unilateral interlaminar approach for bilateral endoscopic decompression in the treatment of LSS demonstrated both safety and efficacy, as evidenced by clinical and radiographic outcomes.

Keywords

endoscopic decompression without fusion or fixation / lumbar spinal stenosis / spinal endoscopic surgery / unilateral interlaminar approach

References

[1] T. Deer, D. Sayed, J. Michels, Y. Josephson, S. Li, and A. K. Calodney, “A Review of Lumbar Spinal Stenosis With Intermittent Neurogenic Claudi Cation: Disease and Diagnosis,” Pain Medicine 20, no. Supplement_2 (2019): S32-S44.

[2] M. Sąsiadek and J. Jacków-Nowicka, “Degenerative Disease of the Spine: How to Relate Clinical Symptoms to Radiological Findings,” Advances in Clinical and Experimental Medicine 33, no. 1 (2024): 91-98.

[3] M. Lacroix, C. Nguyen, R. Burns, A. Laporte, F. Rannou, and A. Feydy, “Degenerative Lumbar Spine Disease: Imaging and Biomechanics,” Seminars in Musculoskeletal Radiology 26, no. 4 (2022): 424-438.

[4] G. C. Machado, P. H. Ferreira, R. I. J. Yoo, et al., “Surgical Options for Lumbar Spinal Stenosis,” Cochrane Database of Systematic Reviews 11, no. 11 (2016): Cd012421.

[5] M. Barutçuoğlu, M. Mete, U. U. Unsal, A. İ. Gurgen, and Y. K. Duransoy, “Comparison of Three Surgical Approaches for the Treatment of Lumbar Spinal Stenosis: Total Laminectomy, Unilateral Approach for Bilateral Decompression, and Total Laminectomy With Posterior Transpedicular Screw Fixation,” Neurological Sciences and Neurophysiology 41, no. 4 (2024): 203-210.

[6] C. Muliagus Rimbana and H. Imam, “The Analysis Study of Surgical Intervention of Degenerative Lumbar Spinal Stenosis: A Comprehensive Systematic Review,” International Journal of Medical Science and Health Research 9, no. 3 (2025): 39-66.

[7] F. Alanazi, “Electric Vehicles: Benefits, Challenges, and Potential Solutions for Widespread Adaptation,” Applied Sciences 13, no. 10 (2023): 6016.

[8] K. Azevedo, L. Quaranta, F. Calefato, and M. Kalinowski, A Multivocal Literature Review on the Benefits and Limitations of Automated Machine Learning Tools. arXiv.org (2024).

[9] J. L. Goldberg, R. Härtl, and E. Elowitz, “Challenges Hindering Widespread Adoption of Minimally Invasive Spinal Surgery,” World Neurosurgery 163 (2022): 228-232.

[10] A. Matzen, A. Rüffer, M. Byllemos, et al., “Challenges and Potential Improvements for Passkey Adoption—A Literature Review With a User-Centric Perspective,” Applied Sciences 15, no. 8 (2025): 4414.

[11] T. Aihara, K. Endo, H. Suzuki, et al., “Long-Term Outcomes Following Lumbar Microendoscopic Diskectomy and Microendoscopic Decompression: Minimum 10-Year Follow-Up Evaluation Performed Using a Patient-Based Outcome Measure,” Journal of Neurological Surgery, Part A: Central European Neurosurgery 81, no. 2 (2019): 163-169.

[12] S. Gupta, N. Marathe, H. S. Chhabra, and J. Destandau, “Long-Term Functional Outcomes of Endoscopic Decompression With Destandau Technique for Lumbar Canal Stenosis,” Asian Spine Journal 15, no. 4 (2021): 431-440.

[13] R. J. Perez-Roman, W. Gaztanaga, V. M. Lu, and M. Y. Wang, “Endoscopic Decompression for the Treatment of Lumbar Spinal Stenosis: An Updated Systematic Review and Meta-Analysis,” Journal of Neurosurgery. Spine 36, no. 4 (2022): 549-557.

[14] N. Khattar, M. Koutourousiou, J. D. Chabot, et al., “Endoscopic Endonasal and Transcranial Surgery for Microsurgical Resect Ion of Ventral Foramen Magnum Meningiomas: A Preliminary Experience,” Operative Neurosurgery 14, no. 5 (2017): 503-514.

[15] S. Sanchez-Gomez, R. Moreno-Luna, D. Martin-Jimenez, et al., “The Lamella Ostium Extent Mucosa (LOEM) System: A New Classification for Endoscopic Sinus Surgery,” Rhinology 63, no. 1 (2024): 125-128.

[16] H. Yan, T. J. Abel, N. M. Alotaibi, et al., “A Systematic Review of Endoscopic Versus Open Treatment of Craniosynos Tosis. Part 2: The Nonsagittal Single Sutures,” Journal of Neurosurgery. Pediatrics 22, no. 4 (2018): 361-368.

[17] H.-S. Kim, P. H. Wu, and I.-T. Jang, “Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety,” Neurospine 17, no. Suppl 1 (2020): S99-S109.

[18] K. Mostofi, M. Peyravi, B. G. Moghaddam, and R. K. Khouzani, “Proposal of a New Anatomical Landmark to Identify the Disc Space in en Doscopic Lumbar Discectomy,” Journal of Craniovertebral Junction and Spine 10, no. 1 (2019): 39.

[19] S. Murata, A. Minamide, H. Iwasaki, et al., “Microendoscopic Decompression for Lumbosacral Foraminal Stenosis: A Novel Surgical Strategy Based on Anatomical Considerations Using 3D Image Fusion With MRI/CT,” Journal of Neurosurgery: Spine 33, no. 6 (2020): 789-795.

[20] J. Aaen, I. M. Austevoll, C. Hellum, et al., “Clinical and MRI Findings in Lumbar Spinal Stenosis: Baseline Data From the NORDSTEN Study,” European Spine Journal 31, no. 6 (2021): 1391-1398.

[21] J. Aaen, H. Banitalebi, I. M. Austevoll, et al., “The Association Between Preoperative MRI Findings and Clinical Improvement in Patients Included in the NORDSTEN Spinal Stenosis Trial,” European Spine Journal 31, no. 10 (2022): 2777-2785.

[22] K. Indrekvam, I. F. Bånerud, E. Hermansen, et al., “The Norwegian Degenerative Spondylolisthesis and Spinal Stenosis (NORD STEN) Study: Study Overview, Organization Structure and Study Population,” European Spine Journal 32, no. 12 (2023): 4162-4173.

[23] L. Dercle, J. McGale, S. Sun, et al., “Artificial Intelligence and Radiomics: Fundamentals, Applications, and Challenges in Immunotherapy,” Journal for Immunotherapy of Cancer 10, no. 9 (2022): e005292.

[24] A. J. Yoo, C. B. L. Majoie, J. Fiehler, et al., “Addressing Heterogeneity in the Large-Core Trials: A Case for Standardized Imaging Analysis,” Stroke 56, no. 5 (2025): 1339-1342.

[25] I. M. Austevoll, E. Hermansen, M. Fagerland, et al., “Decompression Alone Versus Decompression With Instrumental Fusion the NORDSTEN Degenerative Spondylolisthesis Trial (NORDSTEN-DS); Study Protocol for a Randomized Controlled Trial,” BMC Musculoskeletal Disorders 20, no. 1 (2019): 7.

[26] P. Kambin and M. D. Brager, “Percutaneous Posterolateral Discectomy. Anatomy and Mechanism,” Clinical Orthopaedics and Related Research 223 (1987): 145-154.

[27] J. Abitbol, S. Lau, A. V. Ramanakumar, et al., “Evaluating Postoperative Pain and Satisfaction Among Women Treated by Robotic Surgery for Gynecologic Cancer,” Gynecology and Pelvic Medicine 2 (2019): 6.

[28] D. Holguín-Ruacho and C. R. Cervantes-Sánchez, “Calidad y satisfacción del paciente en el manejo laparoscópico ambulat orio de patología vesicular no grave y no complicada,” Cirugia y Cirujanos 87, no. 6 (2019): 656-661.

[29] J. Tonosu, Y. Oshima, Y. Takano, H. Inanami, H. Iwai, and H. Koga, “Degree of Satisfaction Following Full-Endoscopic Cervical Foraminotomy,” Journal of Spine Surgery 6, no. 2 (2020): 366-371.

[30] S. Ahuja, A. N. Moideen, A. G. Dudhniwala, E. Karatsis, L. Papadakis, and E. Varitis, “Lumbar Stability Following Graded Unilateral and Bilateral Facetectomy: A Finite Element Model Study,” Clinical Biomechanics 75 (2020): 105011.

[31] F. Zaina, C. Tomkins-Lane, E. Carragee, S. Negrini, and Cochrane Back and Neck Group, “Surgical Versus Non-Surgical Treatment for Lumbar Spinal Stenosis,” Cochrane Database of Systematic Reviews 2016, no. 1 (2016): Cd010264.

[32] J. Pich, “Effectiveness of Posterior Decompression Techniques Compared With Conventional Laminectomy for Lumbar Stenosis,” Orthopaedic Nursing 37, no. 5 (2018): 318-319.

[33] J. D. Lin, L. A. Tan, A. Tuchman, et al., “Quantitative and Qualitative Analyses of Spinal Canal Encroachment During Cervical Laminectomy Using the Kerrison Rongeur Versus High-Speed Burr,” British Journal of Neurosurgery 33, no. 2 (2019): 131-134.

[34] T. Q. Tabarestani, D. S. Salven, D. A. W. Sykes, et al., “Using Novel Segmentation Technology to Define Safe Corridors for Minim Ally Invasive Posterior Lumbar Interbody Fusion,” Operative Neurosurgery 27, no. 1 (2023): 14-22.

[35] A. A. Salim, A. H. Yusof, J. Johari, and M. I. Yusof, “Feasibility of Unilateral Approach for Bilateral Decompressive Endoscopic Spinal Surgery for Lumbar Stenosis to Improve Back and Leg Pain: A Consecutive Single-Center Series of 60 Patients,” Frontiers in Surgery 7 (2020): 507954.

[36] S. Ruetten and M. Komp, “Endoscopic Lumbar Decompression,” Neurosurgery Clinics of North America 31, no. 1 (2020): 25-32.

[37] B. L. Ye, X. F. Wang, S. L. Li, et al., “Treatment of Senile Lumbar Spinal Stenosis by Unilateral Approach and Bilateral Decompression With Large Channel Endoscopy,” Zhongguo Gu Shang 34, no. 1 (2021): 8-14.

[38] C. W. Lee, K. J. Yoon, and J. H. Jun, “Percutaneous Endoscopic Laminotomy With Flavectomy by Uniportal, Unilateral Approach for the Lumbar Canal or Lateral Recess Stenosis,” World Neurosurgery 113 (2018): e129-e137.

[39] M. Abbas, A. Elwany, and R. Farag, “Efficacy and Safety of Using Unilateral Approach for Bilateral Neural Decompression in Lumbar Spinal Stenosis,” Egyptian Spine Journal 24, no. 1 (2017): 42-49.

[40] S. Ko and T. Oh, “Comparison of Bilateral Decompression via Unilateral Laminotomy and Co Nventional Laminectomy for Single-Level Degenerative Lumbar Spinal Ste Nosis Regarding Low Back Pain, Functional Outcome, and Quality of Life—A Randomized Controlled, Prospective Trial,” Journal of Orthopaedic Surgery and Research 14, no. 1 (2019): 252.

[41] T. Kerimbayev, Y. Kenzhegulov, Z. Tuigynov, et al., “Transforaminal Endoscopic Discectomy Under General and Local Anesthesia: A Single-Center Study,” Frontiers in Surgery 9 (2022): 873954.

RIGHTS & PERMISSIONS

2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.