Endoscopic Interlaminar Standalone Decompression for Lumbar Lateral Recess Stenosis With Subligamentous Disc Herniation: A Disc-Preserving Alternative to Discectomy.

Objective: Lumbar lateral recess stenosis (LRS) with subligamentous disc herniation often causes debilitating radicular pain. While discectomy is commonly performed, it risks disc degeneration and spinal instability. This study aimed to evaluate the clinical and radiographic outcomes of full-endoscopic interlaminar standalone decompression as a minimally invasive, disc-preserving alternative to discectomy for treating single-level LRS with subligamentous disc herniation.

Methods: We retrospectively reviewed 55 patients with single-level lumbar LRS and subligamentous disc herniation who underwent full-endoscopic interlaminar standalone decompression between 2013 and 2021. Inclusion criteria required radicular pain refractory to conservative treatment and magnetic resonance imaging (MRI) confirmation of subligamentous herniation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Short Form-12 Physical and Mental Component Scores (SF-12 PCS/MCS). Radiographic evaluations included disc height index (DHI) measurements and Bartynski grading for lateral recess stenosis. Pre- and postoperative data were compared using the Wilcoxon signed-rank test.

Results: At the 2-year follow-up, leg and back pain VAS scores improved significantly from 8.8 and 8.5 preoperatively to 1.0 and 0.9, respectively. ODI scores declined from 66.9 to 10.6, while SF-12 PCS and MCS improved from 30.1 to 42.5 and 26.3 to 42.6, respectively. According to the modified MacNab criteria, 96.3% of patients achieved "good" or "excellent" outcomes. Postoperative DHI remained stable, and no reoperations were required during follow-up.

Conclusions: Full-endoscopic interlaminar standalone decompression offers substantial symptom relief and functional improvement for single-level lumbar LRS with subligamentous disc herniation. By preserving disc integrity, this minimally invasive technique avoids the risks associated with discectomy, such as disc degeneration and instability. These findings suggest a paradigm shift in treating LRS, supporting the use of this disc-preserving approach as a viable alternative to conventional surgical methods in properly selected patients. Further research with larger cohorts and longer follow-up is warranted to validate these results.