Objective: Lumbar spinal stenosis (LSS) is a common degenerative spinal disease in middle-aged and elderly populations. With the increasing aging of the population, its prevalence continues to rise, significantly affecting the quality of life of elderly patients. Unilateral biportal endoscopy (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) are currently the mainstream minimally invasive procedures for treating LSS in the elderly. However, there is no consensus on the comparative clinical efficacy of these two techniques. This study aims to compare the clinical efficacy and safety of UBE and PTED in treating elderly LSS, identify the advantages and appropriate patient populations for each technique, and provide reliable clinical evidence for individualized surgical decision-making.
Methods: Retrospective data from 60 elderly patients with LSS who underwent minimally invasive treatment at the 900th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army between February 2023 and February 2025 were collected. All patients were aged ≥60 years, met the diagnostic criteria for LSS, and had failed conservative treatment for more than 3 months. The patients were divided into two groups based on the surgical procedure: the UBE group and the PTED group, with 30 patients in each group. Baseline characteristics (gender, age, body mass index, affected segments, duration of symptoms, etc.) did not differ significantly between the two groups (P > 0.05), ensuring comparability. The UBE group underwent vertebral canal decompression using the unilateral biportal endoscopy technique, while the PTED group received treatment using the percutaneous transforaminal endoscopic technique. Perioperative indicators (surgical time, postoperative hospital stay, complication rate), visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) lumbar function scores, and the modified MacNab outcome at 6 months postoperatively were compared between the two groups. All data were analyzed using SPSS 26.0. Continuous variables are presented as mean ± standard deviation (x̄ ± s) and compared using independent-sample t-tests. Repeated measures were analyzed using repeated-measures ANOVA. Categorical variables are presented as number (percentage) [n(%)] and compared using chi-square tests. P < 0.05 was considered statistically significant.
Results: All patients in both groups successfully completed the surgery without severe intraoperative complications. All incisions achieved primary healing, with no adverse events such as incision infection or intraspinal hematoma. The perioperative indicators showed that the UBE group had a significantly shorter surgical time compared to the PTED group (66.5 ± 9.8 min vs 81.3 ± 11.7 min, P < 0.05). There were no significant differences in postoperative hospital stay (5.2 ± 1.1 days vs 4.9 ± 1.0 days) or complication rates (3.3% vs 6.7%) between the two groups (P > 0.05). In the UBE group, one case of nerve root irritation occurred, while in the PTED group, one case of dural sac rupture and one case of nerve root irritation occurred; all cases were successfully treated with conservative management. Efficacy evaluation showed that VAS scores, ODI, and JOA scores improved significantly in both groups at all postoperative time points compared to preoperatively (P < 0.05), indicating that both techniques effectively alleviated lower back and leg pain and improved lumbar function. There were no significant differences in these scores between the two groups at preoperative and 1-month postoperative assessments (P > 0.05), suggesting comparable short-term clinical outcomes. At 3 and 6 months postoperatively, the UBE group had significantly lower VAS scores and ODI and significantly higher JOA scores compared to the PTED group (P < 0.05), indicating that the UBE technique was more effective in pain relief and lumbar function recovery over the medium to long term. The modified MacNab outcome at 6 months postoperatively showed an excellent/good rate of 93.3% in the UBE group and 90.0% in the PTED group, with no significant difference between the two groups (P > 0.05), indicating that both techniques achieved ideal overall treatment outcomes.
Conclusion: Both UBE and PTED techniques are highly safe and effective for treating elderly LSS, with comparable short-term clinical outcomes. Both techniques can effectively alleviate clinical symptoms and improve lumbar function. The UBE technique has advantages in reducing surgical time, improving medium to long-term pain relief, and enhancing lumbar function recovery, making it particularly suitable for elderly patients with complex lesions such as multi-segmental stenosis and central canal stenosis. The PTED technique, characterized by less trauma and less intraoperative bleeding, is more suitable for elderly patients with single-segment lesions, poor physical condition, and low tolerance to surgical trauma. In clinical practice, the choice of the appropriate minimally invasive technique should be individualized based on the specific condition, lesion type, and overall health status of the patient to achieve the best treatment outcomes and improve prognosis and quality of life.
Keywords: Lumbar spinal stenosis, Unilateral biportal endoscopy, Percutaneous transforaminal endoscopic discectomy, Minimally invasive treatment
