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Bilateral-Contralateral Endoscopic Decompression as a Fusion-Deferral Strategy in Upper Lumbar Stenosis: A Structural

Dong Hyun Lee1, Sang Yeop Han2, Seung Young Jeong3

  • 1Department of Neurosurgery, Spine Center, Nanoori Gangnam Hospital, Seoul 06048, Republic of Korea.

Journal of Clinical Medicine
|August 28, 2025
PubMed
Summary

This study introduces a novel facet-preserving decompression technique for upper lumbar spinal stenosis. The unilateral biportal endoscopy (UBE) approach effectively relieves symptoms and preserves spinal stability, potentially deferring fusion.

Keywords:
adjacent segment disease (ASD)bilateral–contralateralendoscopic decompressionfacet jointfusion deferralspondylolisthesisunilateral biportal endoscopy (UBE)upper lumbar stenosis

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Minimally Invasive Spine Surgery

Background:

  • Upper lumbar spinal stenosis poses surgical challenges due to vertical facet joints and narrow laminae, increasing instability risk.
  • Traditional decompression can damage facet joints, leading to further degeneration and instability.
  • A novel facet-preserving approach is needed to mitigate these risks and defer spinal fusion.

Purpose of the Study:

  • To introduce and evaluate a novel, facet-preserving bilateral-contralateral decompression strategy using unilateral biportal endoscopy (UBE).
  • To assess the efficacy of this technique in deferring spinal fusion for upper lumbar stenosis with specific anatomical characteristics.

Main Methods:

  • Retrospective case series of three patients with upper lumbar stenosis, vertical facets (>60°), and narrow laminae.
  • Selection based on facet angle and laminar morphology criteria.
  • Bilateral-contralateral decompression performed using UBE, focusing on facet preservation.

Main Results:

  • Effective neural decompression and symptom relief achieved in all cases.
  • Facet structures were preserved, and no progression to instability or need for fusion occurred within 6 months.
  • Successful outcomes observed even in cases of adjacent segment stenosis and grade 1 spondylolisthesis.

Conclusions:

  • Bilateral-contralateral decompression via UBE is a viable facet-preserving, fusion-deferring strategy for specific upper lumbar stenosis cases.
  • This technique is particularly relevant for adjacent segment stenosis and grade 1 spondylolisthesis.
  • Further prospective studies are warranted to validate these preliminary findings.