Is the Use of a Unilateral Biportal Endoscopic Approach Associated with Rapid Recovery After Lumbar Decompressive Laminectomy? A Preliminary Analysis of a Prospective Randomized Controlled Trial

• Published in: World neurosurgery 2019-08, Vol.128, p.e709-e718
• Main Authors: Park, Sang-Min, Kim, Gang-Un, Kim, Ho-Joong, Choi, Jae Heouk, Chang, Bong-Soon, Lee, Choon-Ki, Yeom, Jin S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Biportal endoscopic spine surgery; Decompression, Surgical - methods; Degenerative spine; Endoscopy; Female; Fentanyl - administration & dosage; Fentanyl - therapeutic use; Humans; Laminectomy - methods; Length of Stay; Lumbar spinal stenosis; Lumbar Vertebrae - surgery; Male; Middle Aged; Operative Time; Pain Measurement; Postoperative Complications - epidemiology; Prospective Studies; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - surgery; Treatment Outcome; Unilateral laminectomy and bilateral decompression; Visual analog scale
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.04.240

The purpose of this study was to assess the immediate postoperative clinical outcomes and perform a preliminary analysis of the effectiveness of biportal endoscopic approaches to lumbar decompressive laminectomy in the treatment of lumbar spinal stenosis. All participants (64 patients) were randomly assigned in a 1:1 ratio to either the biportal endoscopic lumbar decompressive laminectomy (BE-D) group or the mini–open microscopic lumbar decompressive laminectomy (MI-D) group. Early postoperative outcomes were evaluated using clinical and surgical technique–related outcomes. The visual analog scale (VAS) pain score was measured at 6 time points after surgery (at 4, 8, 16, 24, and 48 hours and 2 weeks). Surgical technique–related outcomes were also analyzed. There were no significant differences in the preoperative demographics between the 2 groups. The VAS pain score from 8 to 48 hours (P < 0.05) was significantly lower in the BE-D group than in the MI-D group. Moreover, the total amount of fentanyl usage was higher in the MI-D group than in the BE-D group after surgery (P = 0.026). The length of hospital stay was lower in the BE-D group than in the MI-D group (P = 0.048). The operative time and creatinine phosphokinase level were not significantly different between the groups (P >0.05). Postoperative drainage was significantly higher in the BE-D group than in the MI-D group. BE-D was associated with rapid pain recovery, low fentanyl usage, and early discharge after surgery, but its other benefits have not yet been shown.