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

[AIM] To compare the clinical outcomes of microsurgery and biportal endoscopic spinal surgery (BESS) in lateral recess stenosis.

[MATERIAL AND METHODS] This study evaluated the outcomes of patients with lumbar lateral recess stenosis who underwent microsurgery or BESS between March 2021 and October 2022. Data from 55 patients undergoing simple decompression were analyzed. The parameters assessed included operative time, visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), hemoglobin levels, hospital stay, complication rates, and requirement for postoperative opioids.

[RESULTS] Between March 2021 and October 2022, 55 patients with lumbar lateral recess stenosis underwent simple decompression: [BESS: n=35, Microsurgery: n=20; and a total of 65 levels (L5?S1: 13.8%, L4?5: 53.8%, L3?4: 24.6%, L2?3: 7.6%)]. Operative times for both procedures were similar (BESS: 89.05 ± 28 min vs. microsurgery: 92.25 ± 33.02 min; p=0.89). The BESS group experienced significantly lower early postoperative back pain (VAS score: 3.57 ± 1.77 vs. 5.5 ± 1.9; p=0.003), and both groups showed longterm improvements in pain (p=0.001). The alleviation of leg pain was comparable (p > 0.05), and the Oswestry Disability Index score improved significantly from 52 ± 13.96 to 27.49 ± 14.2 (p=0.001) in both groups by the third month postoperatively. The BESS group had a smaller drop in hemoglobin levels (0.62 ± 0.53 vs. 2.45 ± 1.74 g/dL; p=0.003), shorter hospital stay (33.97 ± 29.16 vs. 71.4 ± 51.13 hours; p < 0.001), and lower postoperative opioid requirements (37.14% vs. 80%; p=0.0021).

[CONCLUSION] BESS offers a safe, effective alternative to microsurgery for lumbar lateral recess stenosis, providing comparable outcomes along with benefits such as reduced postoperative pain, bleeding, and shorter hospital stays. This biportal endoscopic approach is a promising option for treating lumbar stenosis.