Retrospective Analysis of Unilateral Biportal Endoscopy Versus Open Laminotomy for Lumbar Spinal Stenosis.

Abstract

Lumbar spinal stenosis is a common degenerative condition that causes pain, disability, and reduces quality of life, especially in older adults. Techniques such as Unilateral Biportal Endoscopy (UBE) and Open Unilateral Laminotomy with Bilateral Decompression (ULBD) aim to preserve soft tissues while achieving adequate decompression of neural tissue. The study included 194 patients with symptomatic degenerative lumbar spinal stenosis, of whom 177 patients underwent UBE and 17 patients underwent Open ULBD. Clinical outcomes were measured with the visual analog scale (VAS) for pain, the Oswestry Disability Index (ODI) for functional impairment, and the Japanese Orthopedic Association (JOA) score for neurological recovery before surgery and at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. For both groups, there was a significant difference between baseline and 2 years. We hypothesized that UBE would lead to faster early postoperative recovery while yielding similar long-term outcomes. VAS decreased from 7.06 to 0.67 in the Open ULBD group and from 6.81 to 0.56 in the UBE group. ODI improved from 62.65 to 21.56 in the UBE group and from 66.82 to 24.33 in the Open ULBD group, while JOA increased from 11.91 to 24.89 and from 11.24 to 23.83, respectively. The UBE group had numerically lower estimated blood loss (80.11 ± 45.14 vs. 152.35 ± 125.67 mL) and a shorter hospital stay (12.50 ± 5.73 vs. 15.29 ± 5.47 days), while operative time was similar between groups (129.09 ± 64.88 vs. 130.18 ± 74.37 min). Findings suggested that UBE surgery demonstrated favorable early recovery and improving trends in neurological function, and may represent an effective, minimally invasive option. Future studies should use larger, more balanced cohorts to validate these findings and long-term outcomes.