Gardashkhan KARIMZADA, Demet EVLEKSİZ, Adem DOĞAN, Mehmet Can EZGÜ, Mehmet İlker ÖZER, İlker SOLMAZ
Journal of Turkish Spinal Surgery - 2026;37(4):176-184
Objective: The objective of this study is to evaluate the feasibility, perioperative safety, and early clinical outcomes of unilateral biportal endoscopic lumbar decompression (UBELD) performed under spinal anesthesia in carefully selected patients. Materials and Methods: A retrospective review was conducted on patients who underwent UBELD under spinal anesthesia between April 2024 and June 2025. Cases from two different centers were included in the study. The primary outcome was the successful completion of surgery under spinal anesthesia without conversion to general anesthesia. Secondary outcomes included anesthesia-related adverse events, operative time, surgical complications, and changes in visual analog scale (VAS) scores for back and leg pain and in Oswestry disability index (ODI) scores. Results: The mean operative time was 71.5+/-18.9 minutes. Mild intravenous sedation was required in 10 patients (45.5%). Transient hypotension was observed in five patients (22.7%), bradycardia in two patients (9.1%), and postoperative nausea in four patients (18.2%). Complications included an incidental dural tear, a postoperative spinal epidural hematoma requiring surgical evacuation, and transient urinary retention, each in one patient. Back pain VAS decreased from 7.27+/-1.76 preoperatively to 2.64+/-0.85, corresponding to a mean improvement of 4.64 points [95% confidence interval (CI), 3.89-5.38; p<0.001]. Leg pain VAS decreased from 8.50+/-1.50 to 2.18+/-0.85, with a mean improvement of 6.32 points (95% CI, 5.66-6.98; p<0.001). ODI decreased from 65.41+/-14.78 to 13.64+/-7.29, corresponding to a mean improvement of 51.77 points (95% CI, 44.38-59.16; p<0.001). Conclusion: In our study, we observed that UBELD could be performed under spinal anesthesia in a small, carefully selected group of American Society of Anesthesiologists III-IV patients, and we completed all procedures without switching to general anesthesia. Our findings should not be interpreted as evidence that spinal anesthesia is safer than general anesthesia, but rather as evidence of the feasibility of spinal anesthesia in selected patients.
