Infinity decompression: a stepwise biportal endoscopic over-the-top decompression - surgical technique and outcomes.

PURPOSE: To describe the Infinity Decompression (ID), a standardized 13-step workflow for unilateral biportal endoscopic (UBE) over-the-top (OTT) decompression of lumbar central stenosis, and to compare its perioperative and short-term clinical outcomes with conventional “N” technique with piecemeal flavectomy (N-PF). METHODS: We retrospectively analyzed consecutive patients with single-level lumbar central canal stenosis treated by UBE OTT decompression by the same surgeon. Forty cases treated with N-PF were compared with 40 cases treated with the ID technique. Demographic data, operative time per level, complications and reoperations were recorded. VAS back and leg pain, ODI and modified MacNab were assessed preoperatively and at 6 months. RESULTS: Baseline characteristics were similar between groups. Mean operative time per level was 44.8 ± 5.8 min with ID and 73.0 ± 8.7 min with N-PF (p < 0.001). There were no intraoperative or postoperative complications in the ID group. In the N-PF group, one intraoperative dural tear (2.5%) occurred, managed with only sealant without sequelae; no infections or reoperations were recorded. Both techniques produced significant improvements in VAS back and leg pain and ODI at 6 months (all p < 0.001), with no statistically significant differences between-group in pain or disability scores. Good/excellent MacNab outcomes were 95% in the ID group and 90% in the N-PF group. CONCLUSION: The ID offers a practical, reproducible workflow for UBE OTT decompression that substantially reduces operative time while maintaining equivalent short-term clinical outcomes and a low complication profile compared with N-PF.