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Updated: Jul 16, 2026
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Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis
Published on: February 9, 2024
Targeting the Symptom-Driving Level in Multilevel Lumbar Stenosis Using Unilateral Biportal Endoscopy: A Strategy
Insafe Mezjan1, Aurore Sellier2,3, François Lechanoine4
1Department of Neurosurgery, Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, 54000 Nancy, France.
Journal of Clinical Medicine
|July 15, 2026
Summary
Selective single-level decompression using unilateral biportal endoscopy effectively treats multilevel lumbar spinal stenosis, offering significant clinical improvement with reduced surgical invasiveness and operative time for most patients.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Surgery
Background:
- Multilevel lumbar spinal stenosis (MLSS) presents a surgical challenge with debated optimal decompression extent.
- Multilevel decompression (MLD) may increase invasiveness, while minimally invasive techniques like unilateral biportal endoscopy (UBE) allow targeted approaches.
Purpose of the Study:
- To evaluate clinical outcomes of selective single-level decompression (SLD) using UBE in patients with MLSS.
- To compare SLD with MLD in terms of efficacy and invasiveness.
Main Methods:
- Retrospective observational study of 83 adult patients with MLSS undergoing UBE between December 2022 and July 2025.
- Patients underwent either SLD targeting the primary symptomatic level or MLD.
- Outcomes assessed via Oswestry Disability Index (ODI), lumbar visual analog scale (LVAS), and radicular visual analog scale (RVAS).
Main Results:
- 89% of patients initially underwent SLD, with 88% achieving favorable outcomes without further surgery.
- SLD resulted in significant improvements in ODI, LVAS, and RVAS.
- Operative time was significantly shorter for SLD (58.1 min) compared to MLD (122 min).
Conclusions:
- Selective SLD using UBE is a feasible, minimally invasive approach for selected MLSS patients, yielding significant clinical improvement.
- This strategy reduces operative time and surgical extent compared to MLD.
- A stepwise, symptom-driven approach may be effective, though prospective studies are warranted.
