Clinical Efficacy of UBE-ULBD in Patients With Severe Lumbar Spinal Stenosis and Its Impact on Imaging Manifestations

AIM: This research seeks to evaluate the clinical efficacy of unilateral bilateral endoscopy-unilateral laminotomy for bilateral decompression (UBE-ULBD) in patients with severe lumbar spinal stenosis (LSS) and explore its impact on imaging manifestations. METHODS: Fifty patients with severe LSS receiving treatment from January 2023 to June 2024 were included in this study and retrospectively examined. The participants were divided into the experimental group (n = 27) and the control group (n = 23). The control group underwent conventional open surgery, while the experimental group adopted the UBE-ULBD technique. Primary endpoints included perioperative metrics, such as surgical duration, intraoperative blood loss, postoperative drainage, time to first ambulation, and length of hospital stay. Secondary endpoints included visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, Macnab scores, disc height, dural sac area, and complications. All outcomes were assessed at baseline, 1 month, 6 months, and 1 year postoperatively. Additionally, surgical segment fusion, Macnab scores, intervertebral disc height, and dural sac area were assessed at 6 months and 1 year postoperatively, and complications occurring within 1 year postoperatively were documented. RESULTS: In the experimental group, patients experienced shorter surgery duration, reduced intraoperative amount of bleeding, decreased 24-hour wound drainage, shorter antibiotic administration time, earlier ambulation time, and shorter length of hospital stay compared with the control group (p < 0.001). At 6 months and 1 year post-surgery, the intervertebral disc height and dural sac area in the experimental group were significantly higher than those in the control group (p < 0.001). There was no statistically significant difference in the number of non-fused cases postoperatively between the groups (p > 0.05), but the experimental group showed a better distribution of Macnab scores (p < 0.05). The VAS scores for low back pain in the experimental group were significantly lower than those in the control group at 1 month and 6 months postoperatively (p < 0.05), while the VAS scores for leg pain were significantly lower only at 1 month postoperatively (p < 0.05), but there was no significant difference between the two groups at 1 year after surgery (p > 0.05). The JOA score of the experimental group was significantly higher than that of the control group at 1 month postoperatively (p < 0.05); the ODI score of the experimental group was significantly lower than that of the control group at 1 month, 6 months and 1 year postoperatively (p < 0.05). Besides, there was no statistically significant difference in the incidence of complications between the two groups (p > 0.05). CONCLUSIONS: Compared with open surgery, UBE-ULBD demonstrated superior perioperative outcomes, greater early decompression, and improved early Macnab efficacy in patients with severe LSS, supporting its potential as a minimally invasive treatment option.