Clinical Efficacy and Safety of Arthroscopic-Assisted Uniportal Spinal Surgery Versus Percutaneous Endoscopic Lumbar Decompression in Lumbar Spinal Stenosis: A Retrospective Study

Abstract

Objective: To evaluate the clinical efficacy, safety profile, and clinical outcomes of AUSS versus PELD in single-level LSS treatment. Methods: This retrospective comparative study included 68 consecutive LSS patients treated between January 2023 and January 2024: 35 underwent AUSS and 33 underwent PELD. Primary outcomes included total operative time, extracanal working time, intracanal decompression duration, incision length, fluoroscopy exposure time, intraoperative blood loss, preoperative/postoperative day 3 hemoglobin levels, hospitalization duration, total treatment costs, and postoperative complications. Clinical assessments utilized the visual analog scale (VAS) for axial back/leg pain evaluation, Oswestry Disability Index (ODI) for functional assessment, and modified MacNab criteria for clinical success. Minimum follow-up was 12 months. Results: All 68 patients completed 12-month follow-up with no demographic disparities between groups. AUSS exhibited superior operative efficiency with significantly shorter total operating time (45.6 ± 3.14 vs. 54.6 ± 5.54 min, p < 0.01) and intracanal decompression time (21.25 ± 2.38 vs. 35.4 ± 3.36 min, p < 0.01), although with marginally prolonged extracanal operating time (27.35 ± 3.28 vs. 18.6 ± 3.54 min, p < 0.01). Fluoroscopy duration was significantly reduced in AUSS (7.45 ± 2.39 vs. 38.38 ± 7.62 s, p < 0.01). AUSS required larger incisions (19.74 ± 2.13 vs. 7.83 ± 1.08 mm, p < 0.01) and resulted in higher estimated blood loss (17.18 ± 6.43 vs. 9.53 ± 1.38 mL, p < 0.05), and higher total costs (21937.44 ± 579.36 vs. 17459.44 ± 589.26 ¥, p < 0.05), though without clinically significant changes in hemoglobin levels (130.24 ± 7.02 vs. 130.31 ± 6.25, p > 0.05) and postoperative hospital stay (6.48 ± 2.72 vs. 6.84 ± 1.93 days, p > 0.05). AUSS had lower postoperative VAS-leg pain scores at early postoperative periods (3 days and 1 month) (p < 0.01) and higher patient satisfaction rates (94.29% vs. 84.85% excellent/good outcomes, p < 0.05). One PELD case required secondary surgical interventions within 12 months for persistent radiculopathy, whereas no AUSS patients required reoperations. Overall complication rates were comparable between groups. Conclusion: Both techniques showed similar safety. AUSS offers superior operative efficiency, reduced radiation exposure, and better early clinical outcomes compared to PELD for LSS treatment. Despite slightly larger incisions and increased blood loss, AUSS demonstrates enhanced decompression completeness with lower revision rates, suggesting AUSS as a valuable alternative to PELD, particularly for cases requiring comprehensive neural decompression.