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Objective <p>Unilateral biportal endoscopic spinal surgery (UBE) has demonstrated good decompressive outcomes in patients with conventional lumbar spinal stenosis (LSS). However, its efficacy in patients with LSS accompanied by significant vertebral rotation remains unclear. This study aimed to investigate the surgical techniques and clinical outcomes of unilateral biportal endoscopic decompressive laminectomy for severe LSS combined with vertebral rotation.</p> Methods <p>A retrospective analysis was conducted on the clinical data of 110 patients with single-level severe LSS who underwent UBE decompressive laminectomy between September 2022 and September 2024. Based on preoperative imaging (vertebral rotation angle &gt; 5°), patients were divided into two groups: the LSS group (n = 81, without vertebral rotation) and the Rotation group (n = 29, with vertebral rotation). Demographic data, perioperative indicators (operative time, complications), clinical outcomes [Visual Analog Scale (VAS) score, Macnab criteria], and radiographic results (dural sac cross-sectional area preoperatively and at 3&#xa0;months postoperatively) were collected and compared between the two groups.</p> Results <p>There were no statistically significant differences between the two groups in terms of age, gender, BMI, surgical level, or preoperative stenosis grade (Schizas grade C/D) (<i>P</i> &gt; 0.05). The mean operative time in the Rotation group (86.27 ± 10.65&#xa0;min) was significantly longer than that in the LSS group (67.52 ± 6.37&#xa0;min) (<i>P</i> &lt; 0.05). The incidence of intraoperative dural tear was 2.5% (2/81) in the LSS group and 3.4% (1/29) in the Rotation group, with no statistically significant difference between the two groups. The incidence of postoperative symptomatic epidural hematoma was 11.1% (9/81) in the LSS group and 13.8% (4/29) in the Rotation group. At 3&#xa0;months postoperatively, both groups showed significant improvement in low back pain VAS, leg pain VAS,ODI and dural sac cross-sectional area compared to preoperative values (<i>P</i> &lt; 0.05), but the magnitude of improvement was not statistically different between the groups (<i>P</i> &gt; 0.05). According to the modified Macnab criteria, the excellent/good rate was 93.8% (76/81) in the LSS group and 93.1% (27/29) in the Rotation group, with no statistically significant difference between the groups.</p> Conclusion <p>UBE decompressive laminectomy achieves satisfactory short-term (3-month) clinical outcomes for LSS with mild-to-moderate vertebral rotation, comparable to those without rotation, though operative time is longer. However, long-term spinal stability and deformity progression risk remain to be determined, and extended follow-up is warranted.</p>

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Short-term clinical and radiographic outcomes of unilateral biportal endoscopic decompressive laminectomy for lumbar spinal stenosis with mild-to-moderate vertebral rotation: a retrospective study

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  • 发表日期：

    2026年7月31日

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  • Kepeng Li,
  • Bo Jiang,
  • Siyuan Wang,
  • Ye Han

摘要

Objective

Unilateral biportal endoscopic spinal surgery (UBE) has demonstrated good decompressive outcomes in patients with conventional lumbar spinal stenosis (LSS). However, its efficacy in patients with LSS accompanied by significant vertebral rotation remains unclear. This study aimed to investigate the surgical techniques and clinical outcomes of unilateral biportal endoscopic decompressive laminectomy for severe LSS combined with vertebral rotation.

Methods

A retrospective analysis was conducted on the clinical data of 110 patients with single-level severe LSS who underwent UBE decompressive laminectomy between September 2022 and September 2024. Based on preoperative imaging (vertebral rotation angle > 5°), patients were divided into two groups: the LSS group (n = 81, without vertebral rotation) and the Rotation group (n = 29, with vertebral rotation). Demographic data, perioperative indicators (operative time, complications), clinical outcomes [Visual Analog Scale (VAS) score, Macnab criteria], and radiographic results (dural sac cross-sectional area preoperatively and at 3 months postoperatively) were collected and compared between the two groups.

Results

There were no statistically significant differences between the two groups in terms of age, gender, BMI, surgical level, or preoperative stenosis grade (Schizas grade C/D) (P > 0.05). The mean operative time in the Rotation group (86.27 ± 10.65 min) was significantly longer than that in the LSS group (67.52 ± 6.37 min) (P < 0.05). The incidence of intraoperative dural tear was 2.5% (2/81) in the LSS group and 3.4% (1/29) in the Rotation group, with no statistically significant difference between the two groups. The incidence of postoperative symptomatic epidural hematoma was 11.1% (9/81) in the LSS group and 13.8% (4/29) in the Rotation group. At 3 months postoperatively, both groups showed significant improvement in low back pain VAS, leg pain VAS,ODI and dural sac cross-sectional area compared to preoperative values (P < 0.05), but the magnitude of improvement was not statistically different between the groups (P > 0.05). According to the modified Macnab criteria, the excellent/good rate was 93.8% (76/81) in the LSS group and 93.1% (27/29) in the Rotation group, with no statistically significant difference between the groups.

Conclusion

UBE decompressive laminectomy achieves satisfactory short-term (3-month) clinical outcomes for LSS with mild-to-moderate vertebral rotation, comparable to those without rotation, though operative time is longer. However, long-term spinal stability and deformity progression risk remain to be determined, and extended follow-up is warranted.