Aim:Microsurgical decompression is the gold standard for lateral recess stenosis. Biportal endoscopic spinal surgery (BESS), a newer minimally invasive technique, reduces postoperative instability, muscle damage, and tissue disruption while maintaining clear visualization. This retrospective study compares the clinical outcomes of BESS and microsurgery.
Material and Methods:Patients with lumbar lateral recess stenosis treated with BESS or microsurgery between March 2021 and October 2022 were retrospectively analyzed. Fifty-five patients (35 BESS, 20 microsurgery) undergoing decompression without fusion or instability were included. Operative time, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), hemoglobin changes, hospital stay, complications, and opioid requirements were assessed.
Results:ecompression was performed on 65 levels (L5S1: 13.8%, L45: 53.8%, L34: 24.6%, L23: 7.6%). Operative times were similar (BESS: 89.05 ± 28 min vs. microsurgery: 92.25 ± 33.02 min; p = 0.89). Early postoperative back pain was lower with BESS (VAS 3.57 ± 1.77 vs. 5.5 ± 1.9; p = 0.003). Both groups showed significant long-term pain relief (p = 0.001) and comparable leg pain improvement (p > 0.05). ODI scores improved from 52 ± 13.96 to 27.49 ± 14.2 (p = 0.001) in both groups by 3 months. BESS resulted in less hemoglobin drop (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 reduced opioid use (37.14% vs. 80%; p = 0.0021).
Conclusion:BESS is a safe, effective alternative to microsurgery for lumbar lateral recess stenosis. It achieves comparable decompression outcomes while offering advantages of reduced postoperative pain, blood loss, and hospitalization, making it a promising minimally invasive option.