Minimally invasive spine surgery (MIS) has shown promising results, and endoscopic spine surgery has emerged as a less invasive approach. Although studies have examined the effectiveness of endoscopic surgery for spinal stenosis, no meta-analyses have focused on multilevel cases. This meta-analysis aimed to evaluate the efficacy and safety of uniportal and biportal endoscopy in patients with multilevel spinal stenosis. The patient, intervention, comparison, outcomes, and study criteria were established to guide study selection. Four databases were searched. The outcome measures included patient-reported outcome measures (PROMs), radiological and analytical data, complications, surgery time, length of hospital stay, and blood loss. Review Manager ver. 5.4 software (RevMan; Cochrane, UK) was used for the analysis. Heterogeneity was assessed using the chi-square and I2 tests. Ten studies (n=686) were included. PROMs showed significant improvements in Visual Analog Scale (VAS) scores for back pain (mean difference [MD], 4.07; 95% confidence intervals [CI], 3.72–4.42), leg pain (MD, 5.49; 95% CI, 5.17–5.80), and Oswestry Disability Index (MD, 35.97; 95% CI, 32.46–39.47). MacNab scale results were as follows: excellent (55.37%), good (34.93%), fair (7.58%), and poor (4.06%). C-reactive protein levels did not change significantly; however, hemoglobin levels decreased postoperatively (MD, 1.28; 95% CI, 0.91–1.65). Complications included dural tears (5.46%), hematoma (4.30%), incomplete decompression (3.12%), root injury (2.90%), reoperations/revisions (2.22%), conversion to open or microscopic surgery (1.97%), and transfusions (8.50%). Analysis by levels showed worse VAS leg pain in studies analyzing >30% multilevel stenosis (MD, 4.99; 95% CI, 4.47–5.51 vs. MD, 5.82; 95% CI, 5.63–6.01). Uniportal and biportal endoscopy had similar outcomes, except for a higher incidence of dural tears on biportal endoscopy (uniportal, 3.33%; biportal, 7.05%). This meta-analysis supports endoscopy as an effective and safe option for multilevel lumbar stenoses. It improves long-term pain and functionality, with no significant radiological changes or postoperative inflammation. Complications are few; however, dural tears are more common in biportal endoscopy. Higher multilevel stenosis rates were associated with increased leg pain and a lower likelihood of achieving incomplete decompression.

Minimally invasive spine surgery (MIS) has shown promising results, and endoscopic spine surgery has emerged as a less invasive approach. Although studies have examined the effectiveness of endoscopic surgery for spinal stenosis, no meta-analyses have focused on multilevel cases. This meta-analysis aimed to evaluate the efficacy and safety of uniportal and biportal endoscopy in patients with multilevel spinal stenosis. The patient, intervention, comparison, outcomes, and study criteria were established to guide study selection. Four databases were searched. The outcome measures included patient-reported outcome measures (PROMs), radiological and analytical data, complications, surgery time, length of hospital stay, and blood loss. Review Manager ver. 5.4 software (RevMan; Cochrane, UK) was used for the analysis. Heterogeneity was assessed using the chi-square and I2 tests. Ten studies (n=686) were included. PROMs showed significant improvements in Visual Analog Scale (VAS) scores for back pain (mean difference [MD], 4.07; 95% confidence intervals [CI], 3.72–4.42), leg pain (MD, 5.49; 95% CI, 5.17–5.80), and Oswestry Disability Index (MD, 35.97; 95% CI, 32.46–39.47). MacNab scale results were as follows: excellent (55.37%), good (34.93%), fair (7.58%), and poor (4.06%). C-reactive protein levels did not change significantly; however, hemoglobin levels decreased postoperatively (MD, 1.28; 95% CI, 0.91–1.65). Complications included dural tears (5.46%), hematoma (4.30%), incomplete decompression (3.12%), root injury (2.90%), reoperations/revisions (2.22%), conversion to open or microscopic surgery (1.97%), and transfusions (8.50%). Analysis by levels showed worse VAS leg pain in studies analyzing >30% multilevel stenosis (MD, 4.99; 95% CI, 4.47–5.51 vs. MD, 5.82; 95% CI, 5.63–6.01). Uniportal and biportal endoscopy had similar outcomes, except for a higher incidence of dural tears on biportal endoscopy (uniportal, 3.33%; biportal, 7.05%). This meta-analysis supports endoscopy as an effective and safe option for multilevel lumbar stenoses. It improves long-term pain and functionality, with no significant radiological changes or postoperative inflammation. Complications are few; however, dural tears are more common in biportal endoscopy. Higher multilevel stenosis rates were associated with increased leg pain and a lower likelihood of achieving incomplete decompression.

Minimally invasive spine surgery (MIS) has shown promising results, and endoscopic spine surgery has emerged as a less invasive approach. Although studies have examined the effectiveness of endoscopic surgery for spinal stenosis, no meta-analyses have focused on multilevel cases. This meta-analysis aimed to evaluate the efficacy and safety of uniportal and biportal endoscopy in patients with multilevel spinal stenosis. The patient, intervention, comparison, outcomes, and study criteria were established to guide study selection. Four databases were searched. The outcome measures included patient-reported outcome measures (PROMs), radiological and analytical data, complications, surgery time, length of hospital stay, and blood loss. Review Manager ver. 5.4 software (RevMan; Cochrane, UK) was used for the analysis. Heterogeneity was assessed using the chi-square and I2 tests. Ten studies (n=686) were included. PROMs showed significant improvements in Visual Analog Scale (VAS) scores for back pain (mean difference [MD], 4.07; 95% confidence intervals [CI], 3.72–4.42), leg pain (MD, 5.49; 95% CI, 5.17–5.80), and Oswestry Disability Index (MD, 35.97; 95% CI, 32.46–39.47). MacNab scale results were as follows: excellent (55.37%), good (34.93%), fair (7.58%), and poor (4.06%). C-reactive protein levels did not change significantly; however, hemoglobin levels decreased postoperatively (MD, 1.28; 95% CI, 0.91–1.65). Complications included dural tears (5.46%), hematoma (4.30%), incomplete decompression (3.12%), root injury (2.90%), reoperations/revisions (2.22%), conversion to open or microscopic surgery (1.97%), and transfusions (8.50%). Analysis by levels showed worse VAS leg pain in studies analyzing >30% multilevel stenosis (MD, 4.99; 95% CI, 4.47–5.51 vs. MD, 5.82; 95% CI, 5.63–6.01). Uniportal and biportal endoscopy had similar outcomes, except for a higher incidence of dural tears on biportal endoscopy (uniportal, 3.33%; biportal, 7.05%). This meta-analysis supports endoscopy as an effective and safe option for multilevel lumbar stenoses. It improves long-term pain and functionality, with no significant radiological changes or postoperative inflammation. Complications are few; however, dural tears are more common in biportal endoscopy. Higher multilevel stenosis rates were associated with increased leg pain and a lower likelihood of achieving incomplete decompression.

Objective: This retrospective observational study aimed to determine the safety and effectiveness of full endoscopy in the treatment of multilevel lumbar stenosis. Methods: All patients were aged over 18 and were treated for degenerative lumbar stenosis via full endoscopy. Anthropometric and surgical data were collected, as well as information on the hospital stay. Pain was measured using a visual analogue scale, and functional results were evaluated through the Oswestry Disability Index. Results: Forty-two patients (22 men and 20 women) were included. The mean patient age was 63.8±17.2 years. Thirty-five patients (83.3%) presented with involvement at 2 levels, whereas 7 (16.7%) had 3 affected levels. The mean operative time was 83.6±39.7 minutes, and the mean overall hospital stay stood at 17.6±8.9 hours. Radicular pain decreased from 7.5±1.8 points preoperatively to 0.4±0.9 points at 24 hours from surgery (p<0.001). Similarly, axial pain decreased from 3.4±2.5 points to 0.4±1 points (p<0.001). The Oswestry Disability Index fell from 49.6% preoperatively to 19.7% at 6 months of follow-up (p<0.001). As regards satisfaction with the procedure, 37 patients (88.1%) rated it as excellent and 100% of patients stated that they would undergo it again if required. Moreover, the proportion of patients on opioids was statistically significantly lower at 6 months postoperatively, diminishing from 30.8% (n=12) to 9.8% (n=4) (p<0.001). Conclusion Full endoscopy is a safe and reliable technique for the treatment of central and foraminal multilevel lumbar stenosis, with fewer complications and a shorter hospital stay compared to traditional approaches.

This case report presents a novel simultaneous uniportal endoscopic decompression technique for multilevel lumbar spinal stenosis. We aim to determine the feasibility, safety profile, and preliminary clinical outcomes associated with simultaneous uniportal endoscopic "slalom" decompression performed by 2 surgeons at adjacent lumbar levels. A 66-year-old patient diagnosed with severe lumbar spinal stenosis at the L3–4 and L4–5 levels underwent bilateral decompression using a mirrored uniportal endoscopic technique performed simultaneously by 2 surgeons. An over-the-top approach was used to address neural compression. We evaluated operative time, intraoperative complications, and postoperative clinical outcomes, measured by the Oswestry Disability Index (ODI) and the visual analogue scale (VAS) for pain. Early functional recovery was also assessed. The intervention was completed in 75 minutes without intraoperative complications. The patient ambulated independently within 6 hours postoperatively and was discharged within 24 hours without adverse events. At the 6-week follow-up, the patient showed notable improvements in both VAS and ODI scores compared to baseline. Simultaneous uniportal endoscopic slalom decompression is a safe, efficient, and tissue-sparing approach for managing multilevel lumbar spinal stenosis. This technique may offer substantial benefits in selected high-risk populations. Further prospective studies with larger cohorts are warranted to validate these findings and assess long-term outcomes.

Objective: To analyze and compare postoperative recovery metrics and outcomes in patients undergoing short-duration uniportal endoscopic lumbar discectomy under spinal anesthesia utilizing bupivacaine versus chloroprocaine. Methods: This retrospective study analyzed 24 single-level uniportal endoscopic discectomy cases. Patients received spinal anesthesia in the lateral decubitus position with either bupivacaine (n=12) or chloroprocaine (n=12), with all procedures performed by the same surgeon. Primary postoperative outcomes included motor block duration, time to mobilization and ambulation, postoperative visual analogue scale (VAS) scores, requirement for urinary catheterization, and time to discharge from the Post Anesthesia Care Unit (PACU). Results: A statistically significant difference (p<0.05) was observed in postoperative recovery metrics between the 2 groups. The chloroprocaine group demonstrated expedited postoperative milestones, including earlier ambulation, reduced PACU length of stay, and a more rapid initiation of postoperative rehabilitation compared to the bupivacaine group. Conclusion Spinal anesthesia with chloroprocaine facilitates accelerated postoperative recovery, positioning it as a favorable alternative for short-duration uniportal endoscopic lumbar discectomy. However, its judicious utilization should be restricted to surgical procedures anticipated to last less than 1 hour given its pharmacokinetic profile.

The fully endoscopic technique has become the most effective and safest option for the treatment of lumbar disc herniation. Specifically, the interlaminar approach, which was first described at the beginning of the 21st century, is used for the treatment of L4–5 and L5–S1 intracanal disc herniation. Learning protocolized maneuvers facilitates reproducibility and increases the safety of the procedure. The description of the main maneuvers in this article aims to reduce complications and the learning curve with their widespread implementation.

Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration. Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis. Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p<0.05). Conclusion At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

Objective: In lumbar endoscopic spinal surgery, the choice of a regional anesthetic is important for reducing complications and can affect patient recovery and comfort. Methods: A retrospective analysis was conducted of 66 lumbar microdiscectomies (LMDs) under epidural anesthesia (EA) (n=45) or intradural anesthesia (IA) (n=21) performed by the same surgeon and anesthesiologist. The choice of regional anesthesia in LMD (epidural or intradural) differs between anesthesiologists, and the most frequently anesthetic method used in LMD is general or IA. Results: EA may be more reliable than IA, as it enables the surgeon to perform a neurological exploration by requesting the patient to make leg or foot movements during surgery, but few studies have compared these 2 anesthetic methods in LMD. We found that there was a statistically significant difference (p<0.05) between the 2 groups in the postoperative recovery times and in the use of vasopressors during surgery. Conclusion We suggest that EA reduces the length of time to ambulate, length of stay in the postanesthesia care unit, and the time until initiation of postoperative rehabilitation. Compared to IA, it offers greater hemodynamic stability and allows neurological exploration during surgery.