Clinical Efficacy of Unilateral Biportal Endoscopy with Unilateral Laminotomy for Bilateral Decompression

Unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) is an essential neurosurgical procedure for the treatment of lumbar spinal stenosis. This technique offers significant advantages over traditional full laminectomy and spinal fusion fixation, providing surgeons with greater operational freedom and precision in decompression. The UBE-ULBD procedure stands out because of its distinct working and observation channels, which significantly augment the surgeon's maneuverability. The process begins by marking two 1-cm incisions, approximately 1 cm away from the midpoint of the cranial and caudal extents at the target intervertebral space, using the intersection of the surgical side's laminar gap with the puncture needle as a central reference. This methodical approach ensures that the bilateral channels are interconnected at the laminar gap. After this, meticulous dissection of the soft tissues encircling the laminar gaps for both channels is performed using specialized separation instruments, guaranteeing a clear passage between the observation and working channels. The endoscope is then meticulously positioned within the left observation channel, integrating it with a light source, high-definition imaging system, and an irrigation line for optimal visualization. On the right side, the working channel is adeptly used with a nucleotome and radiofrequency ablation electrode to meticulously remove soft tissues. This step is crucial for exposing the superior edge of the inferior lamina, the laminar gap itself, and the inferior edge of the superior lamina, thereby achieving effective bilateral decompression (Figure 1).Characterized by minimal incisions and rapid postoperative recovery, UBE-ULBD achieves favorable clinical outcomes.^1-3 In Video 1, we present an endoscopic operation of single-segment lumbar decompression via the posterior approach using UBE-ULBD. Additionally, we conducted a retrospective study of 25 patients with lumbar spinal stenosis treated with UBE-ULBD to evaluate the practicality of this technique (Table 1). The mean (standard deviation) operative time for the UBE-ULBD group was 58.44 (6.60), with significant improvements in Oswestry Disability Index and visual analog scale scores at 12 months postoperatively (from 54.21 [5.27] to 10.17 [2.73], and from 5.00 [1.06] to 1.67 [1.65], respectively, P < 0.05). Microdiscectomy ULBD, unilateral uniportal endoscopic with ULBD, and UBE-ULBD are the 3 main surgical approaches for treating bilateral symptoms of lumbar spinal stenosis. Choi et al. ¹ suggest that there is no statistically significant difference in postoperative visual analog scale and Oswestry Disability Index scores among the 3 techniques. However, microdiscectomy ULBD is associated with more pronounced trauma, including denervation pain of muscles. The percutaneous endoscopic ULBD offers shorter operative times and less muscle trauma and blood loss, which may have a multifaceted positive impact on postoperative recovery and symptom alleviation for patients.