A retrospective Chinese study on optical-electromagnetic navigation-guided biportal endoscopic unilateral laminotomy for bilateral decompression in lumbar spinal stenosis: improving precision and efficiency.

STUDY

DESIGN

Retrospective cohort study.

PURPOSE: To evaluate the clinical efficacy and advantages of integrated optical and electromagnetic navigation-guided biportal endoscopic unilateral laminotomy for bilateral decompression (navigation-guided BE-ULBD, Ng-BE-ULBD) in patients with lumbar spinal stenosis (LSS).

OVERVIEW OF LITERATURE: The use of surgical navigation improves procedural precision and contributes to reduced operative time and fluoroscopy exposure. However, currently available navigation systems have notable limitations: optical navigation is influenced by lineof- sight obstruction, while electromagnetic navigation is easily affected by interference from metallic instruments.

METHODS

A retrospective analysis was performed on patients who underwent BE-ULBD for LSS at Beijing Chaoyang Hospital between August 2023 and June 2025. Patients treated using an integrated optical and electromagnetic surgical navigation system were categorized into the Ng-BE-ULBD group (n=84), whereas those treated under conventional C-arm fluoroscopy guidance were included in the Carm- guided BE-ULBD (C-BE-ULBD) group. Baseline demographic and clinical characteristics, operative time, number of fluoroscopy shots, clinical outcomes, and postoperative complications were recorded and compared between the two groups.

RESULTS

The total operative time for both single- and two-level decompressions was significantly shorter in the Ng-BE-ULBD group (81.40 minutes and 144.56 minutes, respectively) than in the C-BE-ULBD group (88.79 minutes and 159.53 minutes, respectively; p <0.05), with the most substantial difference observed in catheter placement time. The total number of fluoroscopy shots was also significantly lower in the Ng-BE-ULBD group (p <0.05). Postoperatively, both groups exhibited significant improvement in pain relief, functional recovery, and patient satisfaction. However, no significant differences were identified between the two groups regarding decompression time, complication rates (Ng-BE-ULBD: 3.6% vs. C-BE-ULBD: 7.3%), postoperative pain or functional improvement, or length of hospital stay (p >0.05).

CONCLUSIONS

The integrated optical and electromagnetic surgical navigation system effectively reduces radiation exposure and shortens operative time, thereby improving surgical efficiency and safety. These findings demonstrate strong clinical potential for this technology in minimally invasive spine surgery.