Single-incision uniportal endoscopic bilateral decompression for two adjacent levels of lumbar spinal stenosis: a technical report.

Endoscopic lumbar decompression has become an important minimally invasive technique for the treatment of lumbar spinal stenosis (LSS). Decompression of adjacent levels often requires multiple skin incisions or portals. Strategies to reduce surgical footprint while maintaining effective neural decompression remain an important goal in minimally invasive spine surgery. To our knowledge, single-incision uniportal bilateral decompression at two adjacent lumbar levels has not been formally described. We describe a single-incision uniportal endoscopic technique that allows bilateral decompression of two adjacent lumbar levels through one paraspinal incision, presented through an illustrative clinical case. Laminotomy, medial facetectomy, and flavectomy were performed using an over-the-top contralateral decompression technique with a standardized operative workflow. Adequate bilateral decompression at L3-4 and L4-5 was achieved through a single 0.7-cm incision. Operative time was 115 minutes with six brief fluoroscopy exposures. The patient experienced immediate postoperative symptom relief and ambulated within 24 hours. At 2- and 6-month follow-up, the visual analogue scale (VAS) score improved from 8 to 0. Postoperative clinical assessment confirmed satisfactory bilateral decompression at both levels. Single-incision uniportal bilateral decompression for two adjacent lumbar levels is technically feasible and may further reduce surgical invasiveness compared with conventional multi-portal techniques. While the individual components of this technique are well-established, their integration into a standardized single-incision workflow represents a meaningful technical refinement. Further studies with larger patient cohorts and longer follow-up are required to validate long-term clinical outcomes.