Comparative Study of the Outcomes of Endoscopic Unilateral Laminotomy for Bilateral Decompression (ULBD) With Destandau Technique and Microscopic ULBD: A Randomized Double-Blinded Study of 685 Patients

Abstract

Objective: Lumbar canal stenosis is a common finding amongst elderly patients visiting spine surgeons for back pain. Uniportal unilateral laminotomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for lumbar canal stenosis. This study compared the clinical outcomes of endoscopic ULBD with Destandau technique and microscopic lumbar canal decompression.Methods: A prospective multicenter study on 685 patients undergoing single-level spinal canal decompression. Patients with axial back pain, lumbar radiculopathy, lumbar canal stenosis & claudication distance <1,000 m were included. Parameters assessed were Dura expansion, thecal sac’s cross-sectional area, horizontal displacement, blood loss, operation time, hospital stay, modified MacNab score, visual analogue score (VAS), side changing (self) status, Oswestry Disability Index (ODI), and the Short-Form 36 for quality of life (QoL).Results: Group 1 (endoscopic ULBD with Destandau technique) had 343 patients and group 2 (microscopic ULBD) had 342 patients. Group 1 had lower horizontal displacement (0.34%±0.21%, p<0.001) and significant improvement of VAS (42.28%±3.20%, p<0.001) at 1-week postsurgery with shorter hospital stay (1±0.2 days vs. 1.8±0.8 days, p<0.01) and significant improvements of ODI and MacNab scores (42.28±3.20 and 85.30%, p<0.001). The 30-second chair test (3.4±0.13 vs. 5.6±2.41, p<0.001), 10-meter walk test (1.0±2.15 vs. 0.55±3.23, p<0.001), and SF-36 physical health component score (48.20±8.46 vs. 74.48±0.54, p<0.001) improved significantly as well. Furthermore, 92% of patients were able to change sides while in bed at 1-week postsurgery. Claudication distance improved significantly in both groups.Conclusion: Group 1 patients had better clinical and functional outcomes within 3 months of surgery than group 2 patients, with improved QoL, shorter hospital stays, claudication distance, and self-side changing ability.