• Yukimasa Yamato, Kosei Nagata, Naohiro Kawamura, Akiro Higashikawa, Yujiro Takeshita, Keiichiro Tozawa, Masayoshi Fukushima, Daiki Urayama, Takashi Ono, Nobuhiro Hara, Naoki Okamoto, Seiichi Azuma, Hiroki Iwai, Shurei Sugita, Yuichi Yoshida, Shima Hirai, Kazuhiro Masuda, Yu Jim, Nozomu Ohtomo, Hideki Nakamoto, So Kato, Yuki Taniguchi, Sakae Tanaka, and Yasushi Oshima.
• Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo City, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo City, Tokyo, Japan.
• World Neurosurg. 2024 Mar 1; 183: e408e414e408-e414.

BackgroundSeveral reports have highlighted comparable surgical outcomes between microendoscopic laminectomy (MEL) and open laminectomy (open) for lumbar spinal stenosis. However, the unilateral approach in MEL may present challenges for the upper lumbar levels, where facet joints are located deeper inside. Our objective was to compare surgical outcomes and radiographic evaluations for single-level decompression cases at L1-L2 or L2-L3 between MEL and open laminectomy.MethodsWe analyzed patients who underwent single-level decompression for upper lumbar spinal stenosis at 12 distinguished spine centers from April 2017 to September 2021. Baseline demographics, preoperative, and 1-year postoperative patient-reported outcomes, along with imaging parameters, were compared between the MEL and open groups. To account for potential confounding, patients' backgrounds were adjusted using the inverse probability weighting method based on propensity scores.ResultsAmong the 2487 patients undergoing decompression surgery, 118 patients (4.7%) underwent single-level decompression at L1-L2 or L2-L3. Finally, 80 patients (51 in the MEL group, 29 in the open group) with postoperative data were deemed eligible for analysis. The MEL group exhibited significantly improved postoperative EuroQol 5-Dimension values compared to the open group. Additionally, the MEL group showed a lower facet preservation rate according to computed tomography examination, whereas the open group had a higher incidence of retrolisthesis.ConclusionsAlthough overall surgical outcomes were similar, the MEL group demonstrated potential advantages in enhancing EuroQol 5-Dimension scores. The MEL group's lower facet preservation rate did not translate into a higher postoperative instability rate.Copyright © 2023 Elsevier Inc. All rights reserved.

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