Comparison Between Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression and Other Decompression Approaches for Lumbar Spinal Stenosis: A Systematic Review.

ABSTRACT

BACKGROUND: Lumbar spinal stenosis affects numerous people globally. Full-endoscopic uniportal interlaminar decompression (FEUID) for lumbar spinal stenosis results in satisfactory outcomes. In this systematic review, we compared technical methods, surgical outcomes, and complications among different types of surgical techniques and discussed the effect of different surgical skill levels. METHODS: A systematic review of studies published from 1990 to January 2022 was performed. Studies related to FEUID were identified using the keywords "interlaminar decompression," "endoscopy," "uniportal," and "percutaneous." The outcomes measured were operative time, blood loss, hospital stay, complications, visual analog scale scores, Oswestry Disability Index scores, and the Macnab criteria. RESULTS: Ten of 306 studies were eligible for inclusion. For FEUID, data for 580 patients and more than 367 levels were collected. All the studies reported significant improvement in mean visual analog scale and Oswestry Disability Index scores, and the mean overall complication rate was 9.5%. Compared with other surgical techniques, FEUID resulted in lower visual analog scale and Oswestry Disability Index scores, complication rates, and blood loss and shorter hospital stay. These surgical parameters were considerably affected by a surgeon's skill level. CONCLUSION: FEUID results in better patient satisfaction with more favorable surgical outcomes and fewer complications. Although more prospective randomized controlled studies are required to confirm these findings, our results indicate that FEUID is a reasonable alternative to traditional lumbar spinal surgery.