Abstract
BACKGROUND CONTEXT
Biportal endoscopic decompressive laminectomy is a widely performed procedure and
shows acceptable clinical outcomes. However, the evidence regarding the advantages
of biportal endoscopic surgery is weak, a randomized controlled trial is therefore
warranted.
PURPOSE
To compare the clinical efficacies of biportal endoscopic and microscopic decompressive
laminectomy in patients with lumbar spinal stenosis.
STUDY DESIGN
Randomized controlled trial.
PATIENT SAMPLE
Sixty-four participants suffering from low back and leg pain with single-level lumbar
spinal stenosis who required decompressive laminectomy.
OUTCOME MEASURES
Outcomes were assessed with the use of patient-reported outcome measures, visual analog
scale (VAS) score for low back and lower extremity radiating pain, Oswestry disability
index (ODI), European Quality of Life-5 Dimensions (EQ-5D) score, and painDETECT for
neuropathic pain. Surgery-related outcomes including operation time, length of hospital
stay, postoperative drainage, and serum creatine phosphokinase were evaluated. Perioperative
(<30 days) and late (1–12 months) complications were also noted.
METHODS
All participants were randomly assigned in a 1:1 ratio to undergo biportal endoscopic
or microscopic decompressive laminectomy. The primary outcome was the ODI score at
12 months after surgery based on a modified intention-to-treat strategy. The secondary
outcomes included VAS score for low back and lower extremity radiating pain, ODI scores,
EQ-5D score, and painDETECT score. There were no sources of funding and no conflicts
of interest associated with this study.
RESULTS
There was no significant difference between groups in the mean ODI score at 12 months
after surgery (30 in the microscopy vs. 29 in the biportal endoscopy group, p=.635).
There were also no significant differences in low back and lower extremity pain VAS
scores, ODI, EQ-5D scores, and painDETECT scores at the 3-, 6-, or 12-month follow-up.
Operation time, length of hospital stay, serum creatine phosphokinase, and perioperative
complications, such as durotomies and symptomatic hematoma, showed no significant
differences between the groups; however, one participant underwent additional revision
surgery 9 months after the index surgery in the microscopy group.
CONCLUSIONS
Despite the study design limitation of relatively short duration of follow-up, this
trial suggests that biportal endoscopic decompressive laminectomy is an alternative
to and offers similar clinical outcomes as microscopic open surgery in patients with
symptomatic lumbar spinal stenosis.
Keywords
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Article info
Publication history
Published online: September 19, 2019
Accepted:
September 16,
2019
Received in revised form:
September 13,
2019
Received:
July 10,
2019
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: S-MP: Nothing to disclose. JP: Nothing to disclose. HSJ: Nothing to disclose. YWH: Nothing to disclose. HH: Nothing to disclose. H-JK: Nothing to disclose. B-SC: Nothing to disclose. C-KL: Nothing to disclose. JSY: Nothing to disclose.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
