Comparative Clinical and Radiological Outcomes of Arthroscopic-Assisted Uniportal Spinal Surgery Versus Unilateral Biportal Endoscopy for Unilateral Laminotomy With Bilateral Decompression in Lumbar Spinal Stenosis: A 2-Year Follow-Up Study.

objectiveUnilateral laminotomy with bilateral decompression (ULBD) is a standard procedure for relieving neural compression. Recently, minimally invasive techniques such as Arthroscopic-assisted uniportal spinal surgery (AUSS) and unilateral biportal endoscopy (UBE) have gained attention as alternatives to traditional methods. However, limited data are available on the comparative clinical and radiological outcomes of AUSS and UBE for ULBD in patients with lumbar spinal stenosis (LSS). This study aimed to compare these outcomes in patients with LSS who underwent ULBD using either AUSS or UBE, with a follow-up period of 2 years.

methodsThis retrospective study evaluated 87 patients with LSS who underwent ULBD using either the AUSS or UBE technique between March 2021 and November 2022. Patients were followed up for at least 2 years. Perioperative outcomes, pain relief assessed using the VAS and ODI, and radiological parameters, including the Cross-Sectional Dural Area (CSA), Disc Height Index (DHI), Translation Motion, Preservation Rate of Facet Joint, and Radiological Progression, were compared between the two groups. Statistical analysis was performed using IBM SPSS version 29. Continuous variables were analyzed using the independent-samples t-test or Mann-Whitney U test, and categorical variables were analyzed using the chi-squared test or Fisher's exact test.

resultsBoth AUSS and UBE techniques showed significant reductions in VAS and ODI scores postoperatively, with no significant differences between the groups at any follow-up. The AUSS group had shorter operative times, less blood loss, and smaller incisions compared to the UBE group. Postoperative CSA of the dural sac increased similarly in both groups. Radiological progression was observed in one patient in the AUSS group and one in the UBE group, but no major complications occurred. More than 90% of patients in both groups reported favorable outcomes based on the Modified Macnab criteria at the final follow-up.

conclusionsAUSS and UBE are both effective minimally invasive techniques for treating LSS through ULBD, achieving similar clinical and radiological outcomes at the two-year follow-up. Although AUSS demonstrated perioperative advantages, including shorter operative time and lower estimated blood loss, patient-centered clinical outcomes were comparable between the two groups.