Purpose:
Conventional decompression is an effective treatment for lumbar spinal stenosis (LSS) but is associated with greater tissue disruption and perioperative morbidity. Microendoscopic laminotomy (MEL) is intended to reduce surgical morbidity; however, concerns persist regarding operative time and complications such as incidental durotomy. This study compares both techniques in terms of clinical outcomes, operative parameters, and complication rates.

Methods:
This is a non-randomized prospective cohort study, conducted over three years (two years for patient enrollment and one year for follow-up). A total of 68 patients with degenerative single-level LSS were included; 34 patients underwent conventional interlaminar decompression (CILD), and 34 patients underwent MEL. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively and at multiple follow-up points. Operative time, intraoperative blood loss, and hospital length of stay were also recorded. Complication rates, including incidental durotomy and reoperation, were evaluated.

Results:
The MEL group demonstrated significantly lower intraoperative blood loss and shorter hospital stays compared with the CILD group, while operative time was significantly longer (p < 0.001). The MEL group showed significantly better VAS back pain scores at the immediate, 3-month, and 6-month follow-ups; however, no significant difference was observed at one year. Similarly, ODI scores were significantly improved in the MEL group at the immediate and 3-month follow-ups, with no significant differences at later follow-up points. There were no significant differences between the groups regarding the incidence of dural tear or reoperation rates.

Conclusion:

MEL provides superior early postoperative recovery but requires technical expertise and is associated with a learning curve that may increase the risk of incidental durotomy during the initial experience. Both groups have similar late follow-up results.

Keywords:
Lumbar spinal stenosis; minimally invasive lumbar decompression; Microendoscopic laminotomy.