Is Biportal Endoscopic Laminectomy Equivalent to Microscopic Laminectomy in Patients With Lumbar Spinal Stenosis? A Multicenter, Assessor-blind, Randomized Clinical Trial
Abstract
BACKGROUND
Lumbar spinal stenosis (LSS) impairs quality of life and is commonly treated with microscopic laminectomy. Some have suggested that biportal endoscopic laminectomy may offer advantages through smaller incisions and reduced tissue trauma. However, it remains unclear whether these theoretical advantages translate into meaningful differences in patient-reported outcomes that patients would actually perceive.
QUESTIONS/PURPOSES
We performed an RCT in which we asked: (1) Does biportal endoscopic laminectomy result in equivalent functional outcomes as measured by the Oswestry Disability Index (ODI) at 1 year compared with microscopic laminectomy? (2) Are pain relief, quality of life measures, and surgery-related outcomes similar between biportal endoscopic laminectomy and microscopic laminectomy? (3) Are adverse event rates comparable between the two surgical techniques?
METHODS
We conducted an assessor-blind RCT at six centers in South Korea. Between July 19, 2021, and April 6, 2023, a total of 120 patients with LSS were randomized to undergo biportal endoscopic laminectomy (n = 60) or microscopic laminectomy (n = 60). At 1 year, 90% (54 of 60) of patients in the biportal endoscopic laminectomy group and 86.7% (52 of 60) of patients in the microscopic laminectomy group were accounted for and fully analyzed. No crossover occurred between treatment groups, and the primary analysis followed a modified intention-to-treat approach. The baseline characteristics were well…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 120 participants or records.
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