Comparison of Microsurgical and Biportal Endoscopic Approach in Lumbar Spinal Stenosis Surgery: Single Center Retrospective Analysis

Introduction: Microsurgical decompression has been key in treating lumbar canal stenosis for decades. Recently, biportal endoscopic spinal surgery (BESS) has emerged, minimizing long-term complications like postoperative instability. Combining microsurgery’s visualization with the minimally invasive benefits of monoportal techniques, BESS reduces muscle damage and preserves tissue. This retrospective study compares clinical outcomes of microsurgery and BESS.

Methods: This retrospective study assessed outcomes from March 2021 to October 2022, comparing microsurgical decompression with BESS for lumbar stenosis. We analyzed data from 55 patients undergoing decompression, excluding those with segmental instability or requiring fusion. Operative time, visual analog scale (VAS), Oswestry Disability Index (ODI), hemoglobin levels, length of hospital stay, complication rates, and postoperative opioid requirements were assessed.

Results: From March 2021 to October 2022, 55 patients with central lumbar stenosis underwent decompression: 35 with biportal endoscopic decompression (BESS) and 20 with microsurgical decompression across 65 levels (L5-S1: 13.8%, L4-5: 53.8%, L3-4: 24.6%, L2-3: 7.6%). Operation times were comparable (BESS: 89.05 ± 28 min vs. microsurgery: 92.25 ± 33.02 min; p=0.89). BESS patients experienced significantly lower early postoperative back pain (VAS 3.57 ± 1.77 vs. 5.5 ± 1.9; p=0.003), with both groups showing long-term improvements (p=0.001). Leg pain reduction was similar (p>0.05), and both groups had significant ODI score improvements (p=0.001), decreasing from 52 ± 13.96 to 27.49 ± 14.2 by month three. BESS patients had smaller hemoglobin drops (0.62 ± 0.53 vs. 2.45 ± 1.74 g/dL; p=0.003), shorter hospital stays (33.97 ± 29.16 vs. 71.4 ± 51.13 hours; p< 0.001), and lower postoperative opioid needs (37.14% vs. 80%; p=0.0021).

Conclusion : BESS provides a safe, effective alternative to traditional microsurgery for lumbar canal stenosis, offering comparable outcomes with benefits like reduced postoperative pain, bleeding, and shorter hospital stays. This biportal endoscopic approach is a promising option for lumbar stenosis treatment.