Delta large-channel endoscopy versus unilateral biportal endoscopy decompressive laminectomy for lumbar spinal stenosis: a prospective randomized controlled trial

Delta large-channel endoscopy and unilateral biportal endoscopy (UBE) are prominent minimally invasive techniques for treating lumbar spinal stenosis, known for minimal tissue damage, clear visualization, and quick recovery. However, rigorous controlled research comparing these procedures is scarce, necessitating further investigation into their respective complications and long-term effectiveness. This randomized controlled trial aims to compare their perioperative outcomes, focusing on postoperative recovery and complications over time. In total, 101 participants were randomly assigned to Delta large-channel endoscopy group (n = 50) or UBE group (n = 51). Primary measures were Oswestry Disability Index (ODI) scores and operation time. Secondary measures included VAS, EQ-5D, JOA scores, intraoperative blood loss, hospital stay duration, and costs. Perioperative complications such as dural tears, incision infections, hematomas, thrombosis, and reoperation rates were recorded. The Delta group consistently showed lower mean ODI scores throughout the follow-up than UBE group, with significant differences at 2 weeks postoperative (P = 0.048), though they were not significant by 1 month (P = 0.124), 2 months (P = 0.821) and 3 months (P = 0.350). Operation times were shorter in the Delta group (P < 0.001). Hospitalization costs and intraoperative blood loss were slightly higher in the UBE group (P < 0.001). No significant differences were noted in the other secondary outcomes at various post-surgery intervals, such as VAS, EQ-5D, JOA scores, hospital stay duration and complications. Both techniques are safe and effective when performed by experienced surgeons. Compared to UBE, Delta large-channel endoscopy can shorten surgery time and reduce blood loss, and more importantly, it promotes faster recovery of lumbar function in the early postoperative period. Name of the registry: Chinese Clinical Trial Registry chictr.org.cn. ( http://www.chictr.org.cn/index.aspx ). Unique Identifying number or registration ID: ChiCTR2300076237. Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.chictr.org.cn/showproj.html?proj=207 ,844. The presented study is the first randomized controlled trial that compares the efficacy and safety of delta large-channel endoscopy versus unilateral biportal endoscopy decompressive laminectomy for spinal stenosis. Our study utilized the current mainstream assessment scoring systems for lumbar spinal conditions, including ODI, JOA, EQ-5D, lumbar pain visual analogue scale (VAS), and leg pain visual analogue scale (VAS), which enhanced the reliability of our research findings. Our study found that Delta large-channel endoscopy promotes faster recovery of lumbar function in the early postoperative period, reduces surgery time, intraoperative blood loss, and hospitalization costs.