Percutaneous Endoscopic Lumbar Decompression for Lumbar Lateral Recess Stenosis: A Systematic Review

This review aims to systematically assess and compare the efficacy, complication rates, and procedural characteristics of percutaneous interlaminar endoscopic discectomy (PIED), percutaneous transforaminal endoscopic discectomy (PTED), and unilateral biportal endoscopy (UBE) in the management of lateral recess stenosis (LRS).

A systematic search was conducted across six databases from inception to March 2025 to identify studies on endoscopic lumbar decompression for LRS. Primary outcomes were pain reduction (VAS) and functional improvement (ODI); secondary outcomes were perioperative metrics, complication rates, and patient satisfaction. Narrative synthesis was applied due to heterogeneity. Study quality was assessed using the Cochrane Risk of Bias Tool, ROBINS-I, and the Downs and Black checklist.

Thirty-six studies involving 2341 patients with 6-60 months of follow-up were included. PIED achieved VAS reductions of 3-5 points and ODI reductions of 40-60%, but with higher complication rates, including dural tears (3-6%) and reoperation rates (5-9.7%). UBE produced VAS improvements of 5-7 points and ODI reductions of 50-70%, with satisfaction >92%, though operative times were longer (48-91 min) and dural tears occurred in 3-6%. PTED showed consistent pain relief (VAS 6-8 to 1-2) and ODI reductions >50%, with satisfaction 85-95%, short operative times (5-30 min), and low complication and reoperation rates (<5%). Overall study quality ranged from low to moderate risk of bias.

PIED, PTED, and UBE all provide effective decompression for LRS. PTED demonstrates the most consistent balance of symptom improvement, safety, and efficiency, while each technique offers distinct advantages for individualized patient selection.