Comparative analysis of clinical efficacy between endoscopic cross-overtop decompression and endoscopic unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis

English Keywords:Spinal endoscopy  Cross-overtop decompression technique  Severe lumbar spinal stenosis  Minimally invasive surgery  Endoscopic unilateral laminotomy and bilateral decompression(Endo-ULBD)

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacies of endoscopic cross-overtop decompression(Cross-overtop) and endoscopic unilateral laminotomy bilateral decompression(Endo-ULBD) in the treatment of severe lumbar spinal stenosis. Methods: A retrospective study was conducted on the patients with single-level severe lumbar spinal stenosis admitted and treated with Cross-overtop decompression(30 cases) and Endo-ULBD(30 cases) in our hospital between July 2021 and December 2022. There were 37 male cases and 23 female cases. The average age of the Cross-overtop group was 66.2±8.8 years, and the average age of the Endo-ULBD group was 71.4±8.7 years. The patients were followed up at 1 week, 3 months, 6 months, and ≥12 months(final) after operation. Clinical outcomes were assessed using the visual analog scale(VAS) score, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) scores. The sagittal diameter of the affected spinal canal was measured to evaluate central canal expansion. Postoperative excellent and good rate of efficacy were determined using the MacNab criteria at 12 months′ or the final follow-up. Results: All 60 patients completed follow-up with a duration ranging from 12 to 25 months. Both groups showed significant improvements in VAS scores for low back and leg pain and ODI at each follow-up interval compared to the previous assessment. The Cross-overtop group demonstrated a greater expansion rate(5.08%) of the sagittal diameter of the central canal at the affected level compared to the Endo-ULBD group(1.59%), with statistically significant differences(P<0.05). At postoperative 12-month or final follow-up, MacNab evaluation revealed an excellent and good rate of 90.0% in the Cross-overtop group and 83% in the Endo-ULBD group. Conclusions: Cross-overtop decompression is one of the minimally invasive endoscopic surgical techniques for treating severe lumbar spinal stenosis, which is safe and effective with distinct advantages.