Microscopic Tubular Unilateral Laminotomy for Bilateral Decompression: A Detailed Surgical Illustration and Single-Arm Cohort Study on Outcomes in Lumbar Canal Stenosis

Context: Microscopic Tubular Unilateral Laminotomy for Bilateral Decompression (MT-ULBD) is a minimally invasive technique for treating lumbar spinal stenosis (LSS). This study evaluates clinical outcomes following MT-ULBD and provides detailed surgical illustrations of the procedure. Aims: To assess MT-ULBD’s effectiveness in reducing pain, improving function, and achieving radiological decompression, while highlighting the surgical technique through illustrations. Methods and Material: A single-center, single-arm cohort study was conducted between September 2024 and April 2025. Ethical approval was obtained. Patients with LSS unresponsive to six months of conservative treatment were included. Clinical outcomes (VAS, ODI), radiological decompression (canal diameter), operative time, blood loss, and hospital stay were analyzed. Surgical illustrations documented each procedural step. Paired t-tests and chi-square/Fisher’s exact tests were used; P < 0.05 was considered significant. Results: Of 44 enrolled patients, 41 completed follow-up (28 females, 13 males; mean age 64.2 ± 7.8 years). VAS scores improved from 7.0 ± 1.2 to 3.0 ± 1.1 (P = 0.002), and ODI from 52.4 ± 8.6 to 22.3 ± 6.1 (P < 0.001). Canal diameter increased from 10.8 ± 1.2 mm to 14.8 ± 1.4 mm (P < 0.001). Mean operative time was 52.3 ± 6.4 minutes, blood loss 37.5 ± 6.8 mL, and hospital stay 4.0 ± 1.1 days. Three patients (7.3%) had surgical site infections; two (4.9%) required reoperation. Conclusions: MT-ULBD is effective and safe for LSS, offering significant clinical and radiological improvement with minimal morbidity. Surgical illustrations enhance procedural clarity.