{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:47:32Z","timestamp":1782276452356,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ICCEME Institute"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Multilevel lumbar spinal stenosis (MLSS) is frequently encountered in patients undergoing surgery for lumbar spinal stenosis, yet the optimal extent of decompression remains debated. While multilevel decompression (MLD) may address all radiological stenotic levels, it may also increase surgical invasiveness and operative time. Minimally invasive endoscopic techniques such as unilateral biportal endoscopy (UBE) allow for targeted decompression and facilitate staged surgical strategies. The aim of this study was to evaluate the clinical outcomes of selective single-level decompression (SLD) using UBE in patients presenting with MLSS. Methods: This retrospective monocentric observational study included consecutive adult patients with MLSS who underwent decompression using UBE between December 2022 and July 2025. MLSS was defined as the presence of at least two lumbar levels with Schizas grade B or higher stenosis. Patients undergoing prior lumbar surgery or presenting with non-degenerative pathology were excluded. Patients underwent either SLD targeting the symptom-driving level or MLD, depending on the surgical strategy. Patient-reported outcomes included the Oswestry Disability Index (ODI), lumbar visual analog scale (LVAS), and radicular visual analog scale (RVAS). Results: Among 305 patients operated on for lumbar spinal stenosis, 83 (27%) presented with MLSS and were included in the study. Seventy-four patients (89%) underwent initial SLD and nine (11%) underwent MLD. Among patients treated with SLD, 9 (12%) required a second decompression during follow-up, whereas 65 patients (88%) achieved favorable outcomes without further surgery. Across the entire cohort, ODI, LVAS, and RVAS improved significantly after surgery. Operative time was significantly longer in the MLD group (122 \u00b1 28.1 min vs. 58.1 \u00b1 12.0 min; p &lt; 0.001). These findings support the feasibility of a symptom-driven selective decompression strategy for MLSS using UBE. In our cohort, most patients experienced meaningful functional improvement after SLD without requiring additional surgery. Although a staged approach may necessitate secondary intervention in a minority of patients, selective decompression may help limit surgical extent in carefully selected patients while preserving favorable clinical outcomes. Conclusions: Selective SLD using UBE was associated with significant clinical improvement in most patients with MLSS while reducing operative time and surgical extent. A stepwise strategy targeting the dominant symptomatic level may represent a feasible minimally invasive approach for selected patients with MLSS. Prospective studies are needed to confirm these findings.<\/jats:p>","DOI":"10.3390\/jcm15134875","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:09:17Z","timestamp":1782270557000},"page":"4875","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeting the Symptom-Driving Level in Multilevel Lumbar Stenosis Using Unilateral Biportal Endoscopy: A Strategy Reappraisal"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4034-2588","authenticated-orcid":false,"given":"Insafe","family":"Mezjan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Centre Hospitalier R\u00e9gional Universitaire de Nancy, Universit\u00e9 de Lorraine, 54000 Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurore","family":"Sellier","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toulon Hyeres Saint Jean Private Hospital, 83100 Toulon, France"},{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Lechanoine","sequence":"additional","affiliation":[{"name":"NeuroNEC Brain & Spine, Strada di Paderna 2, 47895 Domagnano, San Marino"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nacer","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Centre Hospitalier R\u00e9gional Universitaire de Nancy, Universit\u00e9 de Lorraine, 54000 Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3341-2592","authenticated-orcid":false,"given":"Guillaume","family":"Lonjon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orthosud, Clinique St-Jean Sud De France, Santecite Group, 34430 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-2211","authenticated-orcid":false,"given":"Fran\u00e7ois-Xavier","family":"Ferracci","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"},{"name":"Department of Neurosurgery, Clairval Private Hospital, Ramsay Sant\u00e9, 13009 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis-Marie","family":"Terrier","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"},{"name":"Department of Neurosurgery, Clairval Private Hospital, Ramsay Sant\u00e9, 13009 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Cam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"},{"name":"Department of Neurosurgery, Clairval Private Hospital, Ramsay Sant\u00e9, 13009 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9421-168X","authenticated-orcid":false,"given":"Anthony","family":"Melot","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"},{"name":"Department of Neurosurgery, Clairval Private Hospital, Ramsay Sant\u00e9, 13009 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cristini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Monticelli Private Hospital, Ramsay Sant\u00e9, 13008 Marseille, France"},{"name":"Department of Neurosurgery, Clairval Private Hospital, Ramsay Sant\u00e9, 13009 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1001\/jama.2022.5921","article-title":"Diagnosis and Management of Lumbar Spinal Stenosis: A Review","volume":"327","author":"Katz","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e028743","DOI":"10.1136\/bmjopen-2018-028743","article-title":"Lumbar spine surgery across 15 years: Trends, complications and reoperations in a longitudinal observational study from Norway","volume":"9","author":"Grotle","year":"2019","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3233\/BMR-130440","article-title":"Pathoanatomical characteristics of clinical lumbar spinal stenosis","volume":"27","author":"Hu","year":"2014","journal-title":"J. Back. Musculoskelet. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5715","DOI":"10.1007\/s00586-025-09113-3","article-title":"No long term benefit of decompression of a borderline lumbar spinal stenosis level adjacent to a more stenotic index level","volume":"34","author":"Hermansen","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E1367","DOI":"10.1097\/BSD.0000000000000469","article-title":"The Influence of Single-level Versus Multilevel Decompression on the Outcome in Multisegmental Lumbar Spinal Stenosis","volume":"30","author":"Ulrich","year":"2017","journal-title":"Clin. Spine Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1007\/s00701-022-05259-x","article-title":"Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc","volume":"164","author":"Nielsen","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/1556331621995136","article-title":"True Differences in Poor Outcome Risks Between Revision and Primary Lumbar Spine Surgeries","volume":"17","author":"Cook","year":"2021","journal-title":"HSS J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ouyang, J.-Y., Yang, Q.-Y., Chen, L.-L., Li, Q., Zheng, Y.-H., Luo, X., and Tan, B. (2024). A comparative analysis of unilateral biportal endoscopic and open laminectomy in multilevel lumbar stenosis. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1409088"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13018-018-0725-1","article-title":"Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: A multicenter, retrospective analysis","volume":"13","author":"Kim","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s10143-024-02674-9","article-title":"How to begin unilateral biportal endoscopy (UBE) for segmental lumbar degenerative disease: A step-by-step guide to perfect patient positioning and surgical approach, avoiding common pitfalls","volume":"47","author":"Sellier","year":"2024","journal-title":"Neurosurg. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1097\/BRS.0b013e3181d359bd","article-title":"Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images","volume":"35","author":"Schizas","year":"2010","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1056\/NEJMoa0707136","article-title":"Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis","volume":"358","author":"Weinstein","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e224291","DOI":"10.1001\/jamanetworkopen.2022.4291","article-title":"Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis: A Randomized Clinical Trial","volume":"5","author":"Hermansen","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"945","DOI":"10.14444\/8124","article-title":"Patients Undergoing 3-Level-or-Greater Decompression-Only Surgery for Lumbar Spinal Stenosis Have Similar Outcomes to Those Undergoing Single-Level Surgery at 2 Years","volume":"15","author":"Nolte","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1016\/j.wneu.2017.12.033","article-title":"Comparison of Single-Level and Multilevel Decompressive Laminectomy for Multilevel Lumbar Spinal Stenosis","volume":"111","author":"Adilay","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"104327","DOI":"10.1016\/j.bas.2025.104327","article-title":"Comparative analysis of lumbar spinal decompression: Propensity-matched evaluation of multilevel vs. single-level decompression for spinal stenosis","volume":"5","author":"Andersen","year":"2025","journal-title":"Brain Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.spinee.2024.01.010","article-title":"Do patients with lumbar spinal stenosis benefit from decompression of levels with adjacent moderate stenosis? A prospective cohort study from the NORDSTEN study","volume":"24","author":"Tronstad","year":"2024","journal-title":"Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1097\/BRS.0000000000004447","article-title":"Multilevel Decompression Surgery for Degenerative Lumbar Spinal Canal Stenosis Is Similarly Effective with Single-level Decompression Surgery","volume":"47","author":"Yamamoto","year":"2022","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1177\/21925682241303104","article-title":"Outcomes of One Versus Two Level MIS Decompression with Adjacent Level Stenosis","volume":"15","author":"Subramanian","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1177\/21925682211033575","article-title":"Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation","volume":"13","author":"Yoshikane","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_21","first-page":"e24.00371","article-title":"Equivalent Patient-Reported Clinical Outcomes Between Single-Level and Multilevel Biportal Endoscopic Decompression at 5-Year Follow-up","volume":"9","author":"Kim","year":"2025","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"602","DOI":"10.3171\/2015.7.SPINE15304","article-title":"Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: A technical note and preliminary clinical results","volume":"24","author":"Eum","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00701-024-05965-8","article-title":"Unintended dural tears during unilateral biportal endoscopic lumbar surgery: Incidence and risk factors","volume":"166","author":"Yu","year":"2024","journal-title":"Acta Neurochir."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4875\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:03:28Z","timestamp":1782273808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":23,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134875"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134875","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}