Short-term clinical efficacy of unilateral biportal endoscopic unilateral laminectomy for bilateral decompression for lumbar epidural lipomatosis: an observational study.

OBJECTIVE: Evaluation of Multidimensional Clinical Outcomes Following Unilateral Biportal Endoscopic Unilateral Laminectomy for Bilateral Decompression (UBE-ULBD) for Symptomatic Lumbar Epidural Lipomatosis . METHODS: This retrospective study analyzed 15 consecutive patients with lumbar epidural lipomatosis (LEL) who underwent UBE-ULBD between February 2021 and November 2023. Demographic data, surgical techniques, radiographic parameters, and patient-reported outcomes were systematically reviewed. MRI was used to measure the Cross Sectional Area (CSA) of dural sac and paravertebral muscle to evaluate the decompression effect. The range of postoperative spinal canal decompression extent and facet joint preservation rate were evaluated by CT. Dynamic X-ray measurement of intervertebral mobility to assess lumbar stability. Visual Analogue Scale (VAS) was used to evaluate the relief degree of for low back/leg pain at preoperative and postoperative 1/3/6/12-month intervals. Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Scores (JOA) were used to evaluate the functional recovery. Fischgrund criteria were used to determine the global clinical efficacy grading. Group comparisons were performed using repeated-measures ANOVA and paired-samples t-tests. Categorical variables were presented as frequencies (percentages). Statistical significance was defined as P < 0.05. RESULTS: All 15 patients successfully underwent UBE-ULBD, achieving complete removal of adipose tissue in the compressed segments. Each patient was followed for a minimum of 12 months postoperatively. Postoperative CSA of the dural sac was significantly larger than preoperative values (p < 0.001). The atrophy rate of the paraspinal muscles was 4.92%, and 77.78% of facet joints were preserved. No lumbar instability occurred during follow-up. VAS scores for low back and leg pain improved significantly from (7.37 ± 0.62) and (6.31 ± 0.38) preoperatively to (1.46 ± 0.20) and (1.49 ± 0.14) at 12 months postoperatively (P < 0.05). ODI scores improved significantly from (67.93 ± 2.40) preoperatively to (16.60 ± 2.06) at 1 year (P < 0.05). Similarly, JOA scores improved from (8.73 ± 1.94) to (25.93 ± 0.80) (P < 0.05). According to the Fischgrund criteria, 5 patients had excellent outcomes, 8 had good outcomes, 2 had fair outcomes, and the overall Good-to-excellent rate was 86.67%. One patient experienced incisional adipose tissue liquefaction with persistent drainage, which resolved after wound debridement and anti-inflammatory therapy. All patients were free of Complications such as cauda equina injury or cerebrospinal fluid leakage. CONCLUSION: UBE-ULBD demonstrates excellent clinical and radiological outcomes in LEL patients, with minimal complications, making it an effective treatment option.