To explore the surgical techniques of spinal endoscopic unilateral laminotomy for bilateral decompression and discectomy (Endo-ULBDD), and evaluate the clinical efficacy, practicability and safety of 360° spinal canal decompression for patients with lumbar spinal stenosis combined with central lumbar disc herniation.

The clinical and imaging data of patients with degenerative lumbar disease who received Endo-ULBDD at the Affiliated Hospital of Qingdao University from October 2020 to March 2023 were retrospectively analyzed. A total of 62 patients were enrolled, including 35 males and 27 females, aged 56-79 years with an average age of (67.47±9.23) years. All patients had grade 3 disc herniation according to MSU classification, and the preoperative dural sac cross-sectional area was (61.50±18.67) mm². The follow-up period ranged from 6 to 24 months, with an average of (14.8±5.1) months. The visual analogue scale (VAS) for low back and leg pain and Oswestry disability index (ODI) were recorded before surgery, on the next day after surgery, at 1 month, 3 months and the final follow-up. The cross-sectional area of dural sac was measured preoperatively and postoperatively to calculate the improvement rate. Operation duration, time to get out of bed after surgery and hospital stay were recorded. The clinical scores before and after decompression were compared and analyzed, and modified MacNab criteria were adopted to assess clinical efficacy at the last follow-up.

All patients completed the operation successfully, with a mean operative time of (106.67±16.43) min. The VAS scores of low back and leg pain as well as ODI were significantly improved at all postoperative time points compared with preoperative values (P<0.05). The improvement rate of postoperative dural sac cross-sectional area was (545.6±79.72)%, and the excellent and good rate was 93.5% based on modified MacNab criteria. Three patients developed numbness in the innervation area of nerve roots after operation, and all symptoms subsided within 3 months. No severe complications such as dural tear or nerve root injury occurred, and no recurrent cases were observed during the follow-up period.

Endo-ULBDD can achieve complete 360° spinal canal decompression and discectomy for patients with lumbar spinal stenosis combined with central lumbar disc herniation, with definite early clinical efficacy and high safety.