A Retrospective Evaluation of the Look-Back Technique for Improving Early Perioperative Outcomes in Unilateral Laminectomy Bilateral Decompression With Unilateral Biportal Endoscopy.

BACKGROUND: Unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (UBE-ULBD) is widely used for lumbar spinal stenosis (LSS). This study introduces a modified UBE-ULBD technique, the "look-back" technique, aiming to reduce postoperative complications. METHODS: This retrospective study enrolled 88 lumbar spinal stenosis patients, with 45 undergoing conventional UBE-ULBD surgery and 43 undergoing the look-back technique. Baseline characteristics, surgical level distribution, operative time, hemoglobin level, hematocrit level, blood loss, hospital stay, complications, visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index, and modified MacNab criteria were assessed. RESULTS: Demographics, comorbidities, and American Society of Anesthesiologists classifications showed no significant differences between the groups. The calculated blood loss in the look-back group was significantly less than that in the UBE-ULBD group (302 mL [Q1, Q3 166, 424 mL] vs 384 mL [Q1, Q3 267.5, 524 mL], P < 0.05). The VAS for leg pain at 1 day after surgery in look-back group was significantly lower than that in UBE-ULBD group (1.72 ± 0.96/2 [1, 2] vs 2.27 ± 1.25/2 [2, 3], P < 0.05). No significant difference was observed in surgical level distribution, surgical time, preoperative/postoperative hemoglobin or hematocrit level, complications, hospital stay, VAS back pain score at 1 day after surgery, VAS low back/leg pain scores at 1 month and 6 months, Oswestry Disability Index scores at 1 month and 6 months, or MacNab outcome at 6 months. CONCLUSIONS: The look-back technique significantly reduces intraoperative blood loss and early leg pain after UBE-ULBD, although it does not significantly lower the overall complication rate.