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To compare the clinical outcomes and learning curve characteristics of unilateral biportal endoscopic lumbar interbody fusion (UBE-TLIF) and percutaneous uniportal full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in patients with single-segment lumbar degenerative diseases (LDD). A retrospective study was conducted from January 2022 to July 2023, involving a total of 95 patients with single-segment LDD, who were divided into two groups: the Endo-TLIF group and the UBE-TLIF group. The demographic characteristics, radiographic and clinical outcomes, as well as complications were meticulously recorded and analyzed in both groups. The mean operation time of Endo-TLIF group was 224.08 ± 58.90 min, which was significantly longer than that of UBE-TLIF group (169.93 ± 30.86 min) ( P  < 0.05). The perspective times were significantly shortened in the UBE-TLIF group compared with the Endo-TLIF group ( P  < 0.05). The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores showed significant improvement post-operation in both groups ( P  < 0.05). There were no significant differences in VAS, ODI and modified Macnab criteria during the last follow-up periods ( P  > 0.05). Both groups exhibited similar complication rates and fusion rates ( P  > 0.05). CUSUM analysis indicated that the stabilization of operation time occurred after 23 cases for Endo-TLIF and 19 cases for UBE-TLIF, respectively. The safety and efficacy of both Endo-TLIF and UBE-TLIF for the treatment of LDD have been demonstrated. As the number of surgeries increased, the operation time for both procedures decreased. Specifically, after 23 surgeries, the operation time for Endo-TLIF reached a relative stability, while for UBE-TLIF it was achieved after 19 surgeries.

Background Minimally invasive spine surgery has seen rapid development in recent years. The purpose of this study was to evaluate the use of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive surgery transforaminal interbody fusion (MIS-TLIF) for the treatment of single-segment lumbar degenerative disease (LDD) through a systematic review and meta-analysis. Methods In collaboration with various search terms, a comprehensive examination of the scientific literature was carried out using PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases. A total of 9 studies were included retrospective cohort studies. Results We observed statistically significant differences in intraoperative blood loss, total hospital stay, postoperative hospital stays, and 1-month postoperative Oswestry Disability Index (ODI) scores between the ULIF and MIS-TLIF groups, with the ULIF group being more dominant. MIS-TLIF group was statistically more advantageous in terms of operative time. There were no statistically significant differences in postoperative visual analogue scale (VAS) scores, 3-month postoperative and final ODI scores, excellent and good rate, complications, disc heights, and lumbar lordosis angle between the two groups. Conclusions Treatment of single-segment LDD with ULIF and MIS-TLIF is both safe and effective. ULIF has the advantage of less intraoperative blood loss, shorter total hospital stay, shorter postoperative hospital stay, and lower ODI scores at 1 month postoperatively compared to MIS-TLIF. There were no significant differences between ULIF and MIS-TLIF in the treatment of LDD in terms of postoperative VAS scores, 3-month postoperative and final ODI scores, satisfaction rates, fusion rates, complications, disc heights, and lumbar lordosis angle. MIS-TLIF has a shorter procedure time than ULIF.

Objectives To compare the short-term outcomes of unilateral biportal endoscopic lumbar interbody fusion (BLIF) and uniportal endoscopic lumbar interbody fusion (ULIF). Methods Sixty patients diagnosed with L4/5 spinal stenosis who underwent BLIF and ULIF were included (30 in each group). Clinical evaluation was performed preoperatively and postoperatively in the 1st week, 1st month, and 1st year. Factors such as the visual analogue score (VAS), Oswestry Disability Index (ODI), operative time, surgical complications, and radiological outcomes (fusion rate, screw loosening, and cage subsidence) were compared between the two groups. Results All patients showed improved mean VAS and ODI at all three postoperative follow-ups, and no statistically significant differences were detected between the BLIF and ULIF groups. The mean operative time in the BLIF group was shorter than that in the ULIF group. Nerve root injury occurred in two patients in the BLIF group, while leakage of cerebrospinal fluid occurred in one patient in the ULIF group. All adverse events were treated adequately prior to discharge. The fusion rates with definite and probable grades were significantly higher in the BLIF group than that in the ULIF group. One case of cage subsidence with no screw loosening occurred in each group. Conclusion Both BLIF and ULIF are safe and effective surgical techniques. Compared with ULIF, BLIF has the advantages of shorter operative time and a higher fusion rate. Other merits of BLIF include a wider surgical field, greater maneuverability of instruments, visibility during cage implantation, and transverse orientation of the cage.

Background Hidden blood loss (HBL) is often ignored unilateral biportal endoscopic interbody fusion surgery (ULIF). We investigated the amount and influencing factors of HBL in ULIF surgery in this study. Methods From October 2020 to November 2023, 100 patients’ clinical and radiological data were retrospectively analyzed. Pearson or Spearman correlation and multivariate linear regression were used to identify factors linked to HBL. Results The mean hidden blood loss (HBL) was 255.84 ± 290.89 ml, making up 62.48% of total blood loss. Correlation analysis showed HBL positively related to ASA classification ( P  = 0.009), operation time ( P  = 0.004), number of operation levels ( P  = 0.046), and paraspinal muscle thickness ( P  = 0.043), but negatively related to tranexamic acid use ( P  = 0.001). A multivariate linear regression analysis showed that HBL was positively associated with ASA classification ( P  = 0.038) and operation time ( P  = 0.046), but negatively associated with tranexamic acid use ( P  = 0.001). Conclusion Patients undergoing ULIF surgery incurred a great deal of HBL. More importantly, ASA classification, operation time and tranexamic acid use were independent risk factors for HBL.

Objectives To identify risk factors associated with cage subsidence (CS) following single segment transforaminal lumbar interbody fusion (TLIF) and unilateral biportal endoscopic lumbar interbody fusion (ULIF) and to compare the predictive performance of various bone quality assessment methods using MRI and CT images. Methods A total of 226 patients from 2021 to 2023 who underwent ULIF/TLIF because of lumbar disc herniation and lumbar spinal stenosis were enrolled. The subsidence of the cage into the vertebral body exceeding 2 mm was defined as CS and diagnosed using CT scans. Immediate endplate destruction (IED) was defined by CT and VBQ was measured through T1-weighted lumbar MRI. The independent sample t-test was employed to examine the risk factors associated with CS. Additionally, risk factors associated with CS were identified using logistic regression analysis. Lastly, the comparative predictive values were assessed through ROC curve analysis. Results Logistic regression analysis revealed that increased postoperative posterior disc height (PPDH), higher segmental VBQ scores, higher mean VBQ (M-VBQ) scores, decreased segmental HU values, decreased mean HU (M-HU) values and immediate endplate destruction (IED) were associated with the occurrence of CS. The area under the curve (AUC) of the VBQ score was higher than that of the HU value, both in segment and in average. Conclusions The incidence of CS was lower in ULIF compared to TLIF. High VBQ scores, low HU values, high PPDH and the presence of IED were associated with an increased risk of CS. Notably, the predictive value of both VBQ scores and HU values were high for CS, with the former potentially outperforming the latter.

Background Unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) has been successfully used to treat degenerative lumbar spinal diseases. Nevertheless, the duration of the UBE-LIF procedure notably exceeds that of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF), increasing the potential for perioperative complications, particularly in elderly patients. Objective This retrospective study aimed to compare the results of robot assistance (RA) and non-assistance (NA) groups and to explore the benefits of UBE-LIF assisted by a Tianji robot in aged patients. Methods 60 patients were divided into two groups: 30 patients in the RA group and 30 in the NA group from January 2022 to June 2023. The surgical duration, estimated intraoperative blood loss, postoperative drainage, length of hospital stays, and radiation exposure were examined and documented. Clinical assessments, including the Oswestry Disability Index (ODI), visual analog scale (VAS), modified MacNab criteria, postoperative complications, and interbody fusion rate, were also evaluated. Results No significant differences were observed between the two groups in terms of postoperative drainage, length of postoperative hospital stay, or fusion rate. However, the RA group exhibited lower perioperative complications, estimated intraoperative blood loss, and duration of radiation exposure than the NA group. The average total operation time in the RA group was 105.3 ± 25.8 min, which was significantly shorter than the NA group’s average of 130.5 ± 22.5 min (P < 0.001). Furthermore, both groups demonstrated improvements in all clinical outcomes at various postoperative time points, with no significant differences between them (P > 0.05). Conclusions Compared with the NA approach, robot-assisted UBE-LIF technology provides accurate intraoperative guidance and helps spinal surgeons achieve accurate decompression. Furthermore, it can reduce radiation exposure, operation time, blood loss, and surgical complications, thereby improving the surgical efficiency and safety.

Background This meta-analysis was performed to comprehensively evaluate the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus uniportal endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) for the treatment of lumbar degenerative diseases. Methods We electronically searched PubMed, Embase, Scopus, Web of Science, the Cochrane Library, the Wanfang Database, and China National Knowledge Infrastructure to identify controlled clinical studies on the efficacy and safety of UBE-TLIF and Endo-TLIF for lumbar degenerative diseases from database establishment to December 2023. Two researchers screened the literature, extracted data, and evaluated the risk of bias of the included studies. They also recorded the authors, sample size, operative time, intraoperative blood loss, hospital length of stay, complication rate, fusion rate, visual analogue scale scores, and Oswestry disability index in each study. The meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Library. Results Five studies involving 314 patients met the inclusion criteria for this meta-analysis. The UBE-TLIF group comprised 154 patients, and the Endo-TLIF group comprised 160 patients. UBE-TLIF was superior to Endo-TLIF in terms of the operative time and fusion rate. There were no significant differences in the intraoperative blood loss, hospital length of stay, complication rate, visual analogue scale scores, or Oswestry disability index between the two groups. Conclusion Both UBE-TLIF and Endo-TLIF can achieve satisfactory clinical results with respect to improving low back and leg pain in patients with lumbar degenerative diseases. However, UBE-TLIF has the advantages of a shorter operative time and higher fusion rate. Trial registration This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023495076).

Objective This study aims to compare the clinical effects and imaging data of patients who underwent endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) with those who received unilateral biportal endoscopic lumbar interbody fusion (ULIF). Methods A retrospective analysis was conducted on the clinical data of 69 patients presenting with typical intermittent claudication and signs and symptoms indicative of unilateral lower extremity nerve root compression, meeting inclusion criteria between April 2022 and June 2022. Among the cohort, 35 patients underwent ULIF group, while 34 patients underwent Endo-TLIF group. We compared perioperative parameters, including intraoperative blood loss, duration of hospital stay, and operation time between the two groups. Pre-operative and post-operative changes in the height and cross-sectional area of the target intervertebral space were also compared between the groups. Finally, we evaluated bone graft size and interbody fusion rates at 6 and 12 months post-surgery using the Brantigan scoring system. Results The ULIF group had significantly shorter operative times compared to the Endo-TLIF group ( P  < 0.05). Conversely, the Endo-TLIF group exhibited significantly shorter hospital stays compared to the ULIF group ( P  < 0.05). However, there were no significant differences in intraoperative bleeding between the two groups ( P  > 0.05). Furthermore, both groups exhibited postoperative increases in vertebral canal volume compared to baseline ( P  < 0.05), with no significant difference in the change in the cross-sectional area of the target intervertebral space between the two surgical methods ( P  > 0.05). Interbody fusion rates were comparable between the two groups at both 6 and 12 months after surgery ( P  > 0.05). Lastly, the ULIF group had a significantly larger area of bone graft than the Endo-TLIF group ( P  < 0.05). Conclusion In summary, the ULIF technique, as a novel spinal endoscopy approach, is a safer and more effective minimally invasive surgical method for addressing lumbar spinal stenosis and intervertebral disc herniation in patients. Both surgical methods have their own advantages and drawbacks. With the development of technology and related instruments, the limitations of both techniques can be mitigated for to a certain extent, and they can be applied by more doctors in diverse medical fields in the future.

Objectives The purpose of this study was to compare the short-term clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with microendoscopic discectomy (MED) for lumbar spondylolisthesis. Methods The patients were divided into MIS-TLIF group and UBE-TLIF group according to the surgical procedures. The two groups were compared in terms of surgery-related parameters, postoperative functional scores and complications. Results Compared with the MIS-TLIF group, the UBE-TLIF group had a longer surgical time, less intraoperative and postoperative blood loss, and less length of stay (LOS) ( p  < 0.001). Comparison of visual analog scale (VAS) scores and Oswestry Disability Index (ODI) scores at each postoperative time point between the two groups showed no statistically significant difference ( p  > 0.05). At the final follow-up, the lumbar lordosis (LL) and Cobb angle were improved in both groups compared with the preoperative period, but the difference between the pre- and postoperative of the two groups was not statistically significant ( p  > 0.05). The intervertebral fusion of the two groups was compared at each postoperative time point, and the difference was not statistically significant ( p  > 0.05). During the follow-up period, there was no statistically significant difference between the two groups in terms of complication rate ( p  > 0.05). Conclusion In the treatment of mild lumbar spondylolisthesis, UBE-TLIF can achieve satisfactory short-term results comparable to MED-assisted MIS-TLIF. Compared with MED-assisted MIS-TLIF, UBE-TLIF has the advantages of less perioperative bleeding, shorter LOS, and faster early postoperative recovery, despite the longer surgical time.

Purpose To evaluate the learning curve and complications in unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) using the Cumulative Sum ( CUSUM ) analysis and Risk-adjusted Cumulative Sum ( RA-CUSUM ) analysis. Methods This study retrospectively analyzed 184 consecutive patients who received ULIF in our hospital, including 104 males and 80 females. CUSUM analysis and RA-CUSUM analysis were used to evaluate the learning curve of ULIF based on the operation time and surgical failure rate, respectively. All postoperative complications were defined as surgical failure. Variables of different phases were compared based on the learning curve. Results The CUSUM analysis showed the cutoff point for ULIF was 29 cases, and the RA-CUSUM analysis showed the cutoff point for ULIF was 41 cases . Operating time and hospital stay were significantly decreased as the learning curve progressed ( P  < 0.05). Visual analogue score (VAS) and Oswestry disability index (ODI) at the last follow-up were significantly lower than preoperatively. At the last follow-up, a total of 171 patients reached intervertebral fusion, with a fusion rate of 92.9% (171/184). A total of eleven complications were observed, and RA-CUSUM analysis showed that the incidence of complications in the early phase was 17.07% and in the late phase was 2.6%, with a significant difference ( P  < 0.05). Conclusion ULIF is an effective minimally invasive lumbar fusion surgical technique. But a learning curve of at least 29 cases will be required to master ULIF, while 41 cases will be required to achieve a stable surgical success rate.