Objective: Unilateral laminotomy with bilateral decompression (ULBD) is a standard procedure for relieving neural compression. Recently, minimally invasive techniques such as Arthroscopic-assisted uniportal spinal surgery (AUSS) and unilateral biportal endoscopy (UBE) have gained attention as alternatives to traditional methods. However, limited data are available on the comparative clinical and radiological outcomes of AUSS and UBE for ULBD in patients with lumbar spinal stenosis (LSS). This study aimed to compare these outcomes in patients with LSS who underwent ULBD using either AUSS or UBE, with a follow-up period of 2 years.
Methods: This retrospective study evaluated 87 patients with LSS who underwent ULBD using either the AUSS or UBE technique between March 2021 and November 2022. Patients were followed up for at least 2 years. Perioperative outcomes, pain relief assessed using the VAS and ODI, and radiological parameters, including the Cross-Sectional Dural Area (CSA), Disc Height Index (DHI), Translation Motion, Preservation Rate of Facet Joint, and Radiological Progression, were compared between the two groups. Statistical analysis was performed using IBM SPSS version 29. Continuous variables were analyzed using the independent-samples t-test or Mann–Whitney U test, and categorical variables were analyzed using the chi-squared test or Fisher's exact test.
Results: Both AUSS and UBE techniques showed significant reductions in VAS and ODI scores postoperatively, with no significant differences between the groups at any follow-up. The AUSS group had shorter operative times, less blood loss, and smaller incisions compared to the UBE group. Postoperative CSA of the dural sac increased similarly in both groups. Radiological progression was observed in one patient in the AUSS group and one in the UBE group, but no major complications occurred. More than 90% of patients in both groups reported favorable outcomes based on the Modified Macnab criteria at the final follow-up.
Conclusions: AUSS and UBE are both effective minimally invasive techniques for treating LSS through ULBD, achieving similar clinical and radiological outcomes at the two-year follow-up. Although AUSS demonstrated perioperative advantages, including shorter operative time and lower estimated blood loss, patient-centered clinical outcomes were comparable between the two groups.
| [1] |
D. B. Anderson, D. J. Beard, F. Rannou, et al., “Clinical Assessment and Management of Lumbar Spinal Stenosis: Clinical Dilemmas and Considerations for Surgical Referral,” Lancet Rheumatology 6, no. 10 (2024): e727–e732, https://doi.org/10.1016/S2665-9913(24)00028-6.
|
| [2] |
H. Aygun and K. Abdulshafi, “Unilateral Biportal Endoscopy Versus Tubular Microendoscopy in Management of Single Level Degenerative Lumbar Canal Stenosis: A Prospective Study,” Clinical Spine Surgery 34, no. 6 (2021): E323–E328, https://doi.org/10.1097/BSD.0000000000001122.
|
| [3] |
D. H. Heo, D. C. Lee, and C. K. Park, “Comparative Analysis of Three Types of Minimally Invasive Decompressive Surgery for Lumbar Central Stenosis: Biportal Endoscopy, Uniportal Endoscopy, and Microsurgery,” Neurosurgical Focus 46, no. 5 (2019): E9, https://doi.org/10.3171/2019.2.FOCUS197.
|
| [4] |
D. H. Heo, S. Sharma, and C. K. Park, “Endoscopic Treatment of Extraforaminal Entrapment of L5 Nerve Root (Far Out Syndrome) by Unilateral Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results,” Neurospine 16, no. 1 (2019): 130–137, https://doi.org/10.14245/ns.1938026.013.
|
| [5] |
T. Lal Motten, “Surgical Outcomes of Unilateral Biportal Endoscopy Versus Full Endoscopy for Lumbar Canal Stenosis: A Meta-Analysis,” Cureus 16 (2024): e76219, https://doi.org/10.7759/cureus.76219.
|
| [6] |
N. Ohtomo, H. Nakamoto, J. Miyahara, et al., “Comparison Between Microendoscopic Laminectomy and Open Posterior Decompression Surgery for Single-Level Lumbar Spinal Stenosis: A Multicenter Retrospective Cohort Study,” BMC Musculoskeletal Disorders 22, no. 1 (2021): 1053, https://doi.org/10.1186/s12891-021-04963-6.
|
| [7] |
A. K. Sharma, R. G. de Oliveira, S. Suvithayasiri, et al., “The Utilization of Navigation and Emerging Technologies With Endoscopic Spine Surgery: A Narrative Review,” Neurospine 22, no. 1 (2025): 105–117, https://doi.org/10.14245/ns.2449404.702.
|
| [8] |
Y. Sheng, J. Li, L. Chen, et al., “Delta Large-Channel Technique Versus Microscopy-Assisted Laminar Fenestration Decompression for Lumbar Spinal Stenosis: A One-Year Prospective Cohort Study,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 43, https://doi.org/10.1186/s12891-023-06143-0.
|
| [9] |
B. Tan, Q.-Y. Yang, B. Fan, and C. Xiong, “Decompression via Unilateral Biportal Endoscopy for Severe Degenerative Lumbar Spinal Stenosis: A Comparative Study With Decompression via Open Discectomy,” Frontiers in Neurology 14 (2023): 1132698, https://doi.org/10.3389/fneur.2023.1132698.
|
| [10] |
K. Su, Q. Yao, M. Liu, et al., “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,” Orthopaedic Surgery 17, no. 6 (2025): 1620–1632, https://doi.org/10.1111/os.70013.
|
| [11] |
Z. Li, Y. Liu, L. Wen, et al., “Short-Term Effectiveness of Uni-Portal Non-Coaxial Spinal Endoscopic Surgery via Crossing Midline Approach in Treatment of Free Lumbar Disc Herniation,” Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 39, no. 1 (2025): 83–87, https://doi.org/10.7507/1002-1892.202409030.
|
| [12] |
T. Wang, H. Yu, S. B. Zhao, et al., “Complete Removal of Intraspinal Extradural Mass With Unilateral Biportal Endoscopy,” Frontiers in Surgery 9 (2022): 1033856, https://doi.org/10.3389/fsurg.2022.1033856.
|
| [13] |
Z. Liu, S. Hao, X. Li, E. Song, and Y. Yao, “Clinical Efficacy of AUSS/UNSES-TLIF in the Treatment of Single-Segment Degenerative Lumbar Spinal Stenosis: A Retrospective Study,” Journal of Orthopaedic Surgery and Research 20, no. 1 (2025): 352, https://doi.org/10.1186/s13018-025-05779-z.
|
| [14] |
B. Zheng, S. Xu, C. Guo, L. Jin, C. Liu, and H. Liu, “Efficacy and Safety of Unilateral Biportal Endoscopy Versus Other Spine Surgery: A Systematic Review and Meta-Analysis,” Frontiers in Surgery 9 (2022): 911914, https://doi.org/10.3389/fsurg.2022.911914.
|
| [15] |
Y. Li, F. Qian, F. Sun, and E. Song, “Arthroscopic-Assisted Uni-Portal Spinal Surgery Combined With Modified Unilateral Laminotomy With Bilateral Decompression for the Treatment of Lumber Epidural Lipomatosis: Case Report and New Therapeutic Method,” Journal of Orthopaedics 58 (2024): 90–95, https://doi.org/10.1016/j.jor.2024.07.003.
|
| [16] |
K.-T. Chen, K.-C. Choi, H.-K. Shim, D.-C. Lee, and J.-S. Kim, “Full-Endoscopic Versus Microscopic Unilateral Laminotomy for Bilateral Decompression of Lumbar Spinal Stenosis at L4–L5: Comparative Study,” International Orthopaedics (SICOT) 46, no. 12 (2022): 2887–2895, https://doi.org/10.1007/s00264-022-05549-0.
|
| [17] |
J. H. Rho, C. D. Yoon, G. Kim, and H. Y. Kang, “A New Technique for Controlling Intractable Pain in Lumbar Spinal Stenosis Using Steroid Injection to Ligamentum Flavum: A Case Series,” Pain Practice 23, no. 1 (2023): 123–126, https://doi.org/10.1111/papr.13133.
|
| [18] |
C. Ammendolia, C. Hofkirchner, J. Plener, et al., “Non-Operative Treatment for Lumbar Spinal Stenosis With Neurogenic Claudication: An Updated Systematic Review,” BMJ Open 12, no. 1 (2022): e057724, https://doi.org/10.1136/bmjopen-2021-057724.
|
| [19] |
S. Jain and N. S. Jassal, “Minimally Invasive Lumbar Decompression,” in Minimally Invasive Surgical Procedures for Pain, 1st ed., ed. D. Sayed, A. Abd-Elsayed, S. Falowski, and T. Deer (Oxford University Press, 2024), 89–104, https://doi.org/10.1093/med/9780197616734.003.0006.
|
| [20] |
A. W. Bahir, W. Daxing, X. Jiayu, L. Bailian, and G. Shao, “Comparative Efficacy and Fusion Outcomes of Unilateral Bi-Portal Endoscopic Transforaminal Lumbar Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Treating Single-Segment Degenerative Lumbar Spondylolisthesis With Lumbar Spinal Stenosis: A Two-Year Retrospective Study,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 835, https://doi.org/10.1186/s13018-024-05315-5.
|
| [21] |
F. Wang, R. Wang, C. Zhang, E. Song, and F. Li, “Clinical Effects of Arthroscopic-Assisted Uni-Portal Spinal Surgery and Unilateral Bi-Portal Endoscopy on Unilateral Laminotomy for Bilateral Decompression in Patients With Lumbar Spinal Stenosis: A Retrospective Cohort Study,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 167, https://doi.org/10.1186/s13018-024-04621-2.
|
| [22] |
Y.-P. Wang, S.-L. Qin, S. Yang, Y.-F. Xu, and P.-F. Han, “Efficacy and Safety of Unilateral Biportal Endoscopy Compared With Microscopic Decompression in the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Updated Meta-Analysis,” Experimental and Therapeutic Medicine 26, no. 1 (2023): 309, https://doi.org/10.3892/etm.2023.12008.
|
| [23] |
L. Yang, L. Zhou, M. Qiu, et al., “A Novel Unilateral bi/Multi-Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results,” Orthopaedic Surgery 17, no. 1 (2025): 192–201, https://doi.org/10.1111/os.14286.
|
| [24] |
J. Xu, D. Wang, J. Liu, et al., “Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis,” Neurospine 19, no. 3 (2022): 792–804, https://doi.org/10.14245/ns.2143116.558.
|
| [25] |
H. Ding, X. Han, Y. Xing, Y. Liu, D. He, and X. Han, “Clinical and Radiological Comparison of Unilateral Biportal Endoscopic and Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Degenerative Disease,” Orthopaedic Surgery 17, no. 4 (2025): 1105–1113, https://doi.org/10.1111/os.14361.
|
| [26] |
K.-B. Kang, Y.-S. Shin, and E.-M. Seo, “Endoscopic Spinal Surgery (BESS and UESS) Versus Microscopic Surgery in Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis,” Global Spine Journal 12, no. 8 (2022): 1943–1955, https://doi.org/10.1177/21925682221083271.
|
| [27] |
C. Zhang, L. Chen, J. Li, D. Huang, W. Zhang, and J. Lin, “Should Posterior Midline Structures be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-Analysis,” Clinical Spine Surgery 35, no. 8 (2022): 341–349, https://doi.org/10.1097/BSD.0000000000001268.
|
| [28] |
A. Suzuki and H. Nakamura, “Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review,” Medicina 58, no. 3 (2022): 384, https://doi.org/10.3390/medicina58030384.
|
| [29] |
Y. Ding, H. Zhang, Q. Jiang, et al., “Finite Element Analysis of Endoscopic Cross-Overtop Decompression for Single-Segment Lumbar Spinal Stenosis Based on Real Clinical Cases,” Frontiers in Bioengineering and Biotechnology 12 (2024): 1393005, https://doi.org/10.3389/fbioe.2024.1393005.
|
| [30] |
Y. Liu, X. Li, H. Tan, et al., “Learning Curve of Uniportal Compared With Biportal Endoscopic Techniques for the Treatment of Lumbar Disc Herniation,” Orthopaedic Surgery 17, no. 2 (2025): 513–524, https://doi.org/10.1111/os.14312.
|
Rights & permissions
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(688KB)
