Percutaneous endoscopic unilateral laminotomy and bilateral decompression improves gait quality and stance balance in patients with lumbar spinal stenosis: a retrospective cohort study

Abstract

Background: Percutaneous endoscopic unilateral laminotomy and bilateral decompression (Endo-ULBD) has been applied to patients with lumbar spinal canal stenosis (LSS). However, it remains unclear whether gait and postural balance in LSS patients fully recover to normal levels following ULBD surgery. Methods: This retrospective study included 60 symptomatic LSS patients (LSS group) and 60 healthy age-matched adults (control group). The LSS group was assessed at four time points: preoperatively, 3, 6, and 12 months postoperatively. Evaluations included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores, as well as assessments of gait and balance. The control group underwent gait and balance evaluations on the day of recruitment. Results: The LSS group showed significant improvement in VAS and ODI at 3, 6, and 12 months after ULBD surgery (p < 0.05). Cadence improved at 3 months postoperatively, while walking speed, stride length, and double support duration improved at 6 months postoperatively. At 12 months postoperatively, there was no significant difference in gait spatiotemporal parameters between the LSS group and the healthy control group (p > 0.05). Preoperatively, the LSS group exhibited differences in COP path length and 90% COP postural sway area compared to the control group. Postoperatively, there was no significant improvement in COP path length at any time point. However, there were differences in 90% COP postural sway area at 12 months after surgery compared to the preoperative and control groups. Conclusion: LSS patients showed significant improvement in gait after ULBD surgery, with gait parameters comparable to those of healthy controls at 12 months. While balance stability improved at 12 months, it remained inferior to that of age-matched healthy controls, indicating that postoperative balance training is necessary for full recovery. Trial registration: This study was a single-center retrospective cohort study, approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Ethical Application Reference: PJ2023-07-13 Anhui, China) and was registered at the Chinese Clinical Trial Registry at 20/06/2023 (ChiCTR2300072649). The research was conducted in accordance with the Declaration of Helsinki and clinical practice guidelines.