Objective To explore the clinical efficacy and technical advantages of ultrasonic osteotome⁃assisted unilateral biportal endoscopy (UBE) for the treatment of severe degenerative lumbar spinal stenosis (DLSS) in the elderly. Methods A retrospective analysis was conducted on the clinical and imaging data of 86 elderly patients with severe DLSS receiving UBE treatment. Patients were assigned to observation group (employing ultrasonic osteotome, 41 cases) or control group (employing traditional instruments, 45 cases) according to the presence of ultrasonic osteotome⁃assisted bony decompression operation used. Operation duration, intraoperative estimated blood loss (IEBL), postoperative drainage volume, postoperative length of hospital stay, and operative complications of the two groups were recorded. The dural sac cross⁃sectional area (DSCA) before and after surgery, the decompression rate of bilateral bony lateral recess after surgery and the resection angle (β angle) of the facet joint on the approach side were measured. The Visual Analogue Scale (VAS) score for low back and legs pain and Oswestry disability index (ODI) of the two groups were compared before surgery, 1 and 3 months after surgery and at the last follow⁃up. The modified MacNab criteria was used to evaluate the clinical efficacy of the two groups at the last follow⁃up. Results All patients successfully completed the surgery. Operation duration, IEBL, postoperative drainage volume, and postoperative length of hospital stay in the observation group were shorter or less than those in the control group (P<0.05). The VAS score for low back and legs pain and ODI of both groups decreased at various time points after surgery as compared with before surgery, and further decreased gradually at 1 month and 3 months after surgery (P<0.05). The observation group exhibited lower VAS score for low back and legs pain and ODI as compared with the control group (P<0.05). DSCA of both groups was increased after surgery compared with before surgery, and the observation group was greater than the control group (P<0.05). There was no statistically significant difference in the decompression rate of bony lateral recess on the approach side between the two groups (P>0.05), but the decompression rate of the contralateral bony lateral recess in the observation group was greater than that in the control group, and the β angle was smaller than that in the control group (P<0.05). The total incidence rate of complications in the observation group was 2.44% (1/41), comparing to 13.33% (6/45) in the control group. At the last follow⁃up, the modified MacNab criteria excellent and good rates of both groups were 95.12% and 84.44%, respectively, but there was no statistically significant difference between the two groups (P>0.05). Conclusion The clinical efficacy and imaging outcomes of ultrasonic osteotome⁃assisted UBE are superior to those of traditional surgical instruments in the treatment of severe DLSS in the elderly, with shorter operation duration, less bleeding volume, and lower incidence rate of operative complications.

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