Outcomes and safety of unilateral biportal endoscopy for lumbar spinal stenosis

To assess the outcomes and safety of unilateral biportal endoscopy (UBE) technique in treating lumbar spinal stenosis (LSS).

A total of 180 LSS cases treated in Nanjing First Hospital, Nanjing Medical University (March 2022-March 2025) were selected, including 85 patients (PTED group) treated with percutaneous transforaminal endoscopic discectomy (PTED) and 95 patients (UBE group) with UBE surgery. Therapeutic outcomes, surgical metrics (operative duration, intraoperative blood loss, and postoperative drainage), clinical indicators (hospitalization duration/costs), lumbar functional recovery (Oswestry Disability Index [ODI]), pain (Visual Analogue Scale [VAS]), laboratory findings (C-reactive protein, CRP; interleukin-6, IL-6; creatine kinase, CK), and safety (infection, nerve root damage, and dural sac rupture) were comparatively assessed across groups. Furthermore, to gain in-depth insights into the predictors of treatment response, both univariate and multivariate analytical methods were applied.

The groups were equivalent in excellent-and-good rates, hospitalization expenses, and overall complication rates. UBE recipients showed higher values in intraoperative bleeding, drainage volume, and hospital stay than PTED-treated cases, but with shorter operative duration. Both cohorts displayed reduced ODI and VAS (lumbago and lower leg pain) scores at one and three months postoperatively compared to their preoperative levels; although differences in postoperative ODI and lower back VAS scores were non-significant between groups, the VAS of leg pain was statistically lower in the UBE group versus the PTED group. In the UBE group, all laboratory indices presented a postoperative rise but remained notably lower relative to the PTED group's values. L5-S1 involvement, combined-type stenosis, a Schizas grade D, and comorbid hypertension were independent predictors of suboptimal efficacy in LSS patients, as established by univariate and multivariate analysis.

When used to treat LSS, UBE demonstrates therapeutic efficacy, safety, and treatment costs comparable to PTED. Yet, UBE contributes to shortened surgical duration, milder post-surgical leg pain, and aids in lessening the abnormal rise of laboratory examination indexes. Nonetheless, UBE is linked to increased intraoperative bleeding, greater drainage volume, and a longer hospitalization period.