Comparison of Clinical Outcomes between Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Comparative Cohort Study

Objective: Microscopic unilateral laminotomy for bilateral decompression (M-ULBD) is an established surgical treatment for lumbar spinal stenosis (LSS).Uniportal full-endoscopic ULBD (E-ULBD) has emerged as a minimally invasive alternative, but evidence comparing the two techniques remains limited.Methods: This retrospective review included patients who underwent E-ULBD or M-ULBD for single-level degenerative LSS between January 2021 and December 2025.We compared demographic characteristics, operative data, postoperative complications, and clinical outcomes between the groups.Back and leg pain were assessed using the visual analog scale (VAS), and disability was assessed using the Oswestry Disability Index (ODI), at baseline and at 1 and 6 months after surgery.Results: Of the 74 patients, 27 underwent E-ULBD and 47 underwent M-ULBD.Compared with M-ULBD, E-ULBD was associated with lower estimated blood loss (79.8 ± 19.9 vs. 112.4± 31.8 mL; p < 0.001), shorter operative time (67.0 ± 8.8 vs. 75.3± 14.4 minutes; p = 0.003), and shorter hospital stay (7.0 ± 2.3 vs. 9.9 ± 2.7 days; p < 0.001).For VAS back pain scores, the group × time interaction was statistically significant (p = 0.002); the E-ULBD group had significantly lower scores at 1 month postoperatively (2.44 ± 0.80 vs. 3.60 ± 1.38; p < 0.001).The group × time interactions for VAS leg pain scores (p = 0.548) and ODI scores (p = 0.762) were not significant, indicating equivalent trajectories of improvement.Conclusion: In appropriately selected patients with single-level LSS, E-ULBD provided clinical outcomes comparable to those of M-ULBD while reducing blood loss and early postoperative back pain and shortening operative time and hospital stay.