Article Figures & Data
Figures
- Figure 1
Position and initial identification of the interlaminar window under C-arm.
- Figure 2
LUSTA endoscopic System (Spinendos, Germany) of 7.1-mm working channel with a 10° view angle (left) and 4.3-mm working channel with a 25° view angle (right), respectively.
- Figure 3
Illustration of the route of endoscopic system insertion for lumbar endoscopic unilateral laminotomy and bilateral decompression (LE-ULBD). (Left) Coronal-section view: The blue arrow indicates 7.1-mm working channel and the red arrow indicates 4.3-mm working channel for ipsilateral and contralateral side decompression in LE-ULBD. (Right) Anteroposterior view: Steps of LE-ULBD by performing (1) ipsilateral cephalad laminotomy, (2) ipsilateral caudal laminotomy, (3) contralateral cephalad laminotomy, and (4) contralateral caudal laminotomy.
- Figure 4
Illustration of endoscopic procedures in lumbar endoscopic unilateral laminotomy for bilateral decompression. (Left) Initial identification of spinolaminar junction. (Middle) Attachment site of ligamentum flavum on the caudal lamina. (Right) Contralateral decompression.
- Figure 5
Illustration of procedures during the unilateral endoscopic laminotomy with bilateral decompression. (Left) Exposure of the dural sac. (Middle) Insertion of working sheath for contralateral decompression. (Right) Well decompression of the dural sac.
- Figure 6
A 4.3-mm working channel endoscopy and sheath using “channel-in-channel” technique in a 7.1-mm endoscopic sheath when performing bilateral decompression.
Tables
Name Design Surgical Techniques Comparison n Findings Operative Time, mean VAS-Leg
(preop)VAS-Leg
(1-y postop)VAS-Back
(preop)VAS-Back
(1-y postop)ODI
(preop)ODI
(1-y postop)Complic-ations Ruetten et al, 2006 Prospective study UEILD NA 331 1. Improved VAS, ODI, NASS scores 2. Neurological deficit significantly reduced 29 min 7.4 0.8 2.1 2.2 79 22 NA Wu et al, 2020 Prospective cohort study UEILD NA 106 1. Improved VAS, ODI, NASS, MacNab scores 2. Fewer
complication 3. Shorter hospitalizaiton duration68.9 min 7.7 1.1 6.8 1.5 62 12 0.94% Ruetten et al, 2009 Prospective randomized controlled study UEILD Microscopic decompression 161 1. Improved VAS, ODI, NASS scores 2. Neurological deficit significantly reduced 3. Shorter operating time 4. Lower complication rates 5. Postop pain reduced 34 min 7.3 0.7 1.6 0.9 78 20 1.20% Komp et al, 2015 Prospective randomized controlled study UEILD Microscopic decompression 135 1. Improved VAS, ODI, NASS scores 2. Neurological deficit significantly reduced 3. Postop pain reduced 4. Shorter hospitalizaiton duration 5. Fewer complications 42 min 8.5 1.8 2.3 1.6 84 29 5% Angela Carrascosa-Granada
2020Prospective, randomized, double-blind study UEILD Microscopic decompression 20 1. Improved ODI, JOA scores 2. Improved walking claudication distance 3. Less blood loss 4. Less disability at 6 mo 125 min 8.0 (overall) 0 (overall) NA NA 72 6 20% Kim et al, 2020 Retrospective cohort Uniportal endoscopic translaminar lumbar decompression Microscopic decompression 60 1. Improved VAS, ODI, and MacNab scores (1 wk) 2. Lower serum CPK and CRP enzyme (day 1 d) 3. Lower horiziontal displacement 58.1 min 7.1 (overall) 1.2 (overall) NA NA 71.2 23.5 3% Lee et al, 2019 Retrospective cohort UEILD Tubular and microscopic decompression 270 1. Less immediate postop pain 2. Less increase in CPK 3. Shorter hospitalizaiton duration 84 min 7 2.5 6 2.2 69.8 34 7.90% Lee et al, 2018 Meta-analysis UEILD N/A 156 1.Improved VAS, ODI scores 69–122 min Difference in means: 5.95 Difference in means: 4.22 Difference in means: 41.71 2.70% Heo et al, 2019 Retrospective cohort UEILD Biportal and microscopic decompression 97 Lower mean dural expansion 61.6 min 7.9 1.9 7 1.8 56.7 23.5 11% Hasan et al, 2019 Retrospective cohort UEILD Microscopic decompression 45 1. Improved VAS, ODI scores 2. Less blood loss 3. Shorter hospitalization duration 4. Fewer periopertaive complications and reoperations NA 6.6 1.5 5.8 1.8 52.8 19.9 7% Pairuchvej et al, 2019 Systemic review and meta-analysis UEILD Biportal and microscopic decompression 994 1. Improved VAS score 2. Fewer complications 3. Significant lower leg pain NA NA NA NA NA NA NA NA Wei et al, 2021 Network meta-analysis Endoscopic decompression Interspinous process spacer device, laminectomy, laminotomy, minimally invasive decompression, non-surgery, split-decompression, decompresison, decompression plus fusion 4341 1. Better short- and long-term disability change 2. Lower complications 3. Shortest hospitalization duration NA NA NA NA NA NA NA NA NA, not available; NASS, North American Spine Society ; ODI, Oswestry Disability Index; postop, postoperative; UEILD, uniportal endoscopic interlaminar lumbar decompression; VAS, visual analog scale.
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